How Does Health in Childhood Impact Labor Market Earnings Over the Life Course? - Steven A Haas; M. Maria Glymour; Lisa F Berkman (Journal of Health and Social Behavior, 2011)
The authors use data from the Health and Retirement Study's Earnings Benefit File, which links Health and Retirement Study to Social Security Administration records, to estimate the impact of childhood health on earnings curves between the ages of 25 and 50 years. They also investigate the extent to which diminished educational attainment, earlier onset of chronic health conditions, and labor force participation mediate this relationship. Those who experience poor childhood health have substantially diminished labor market earnings over the work career. For men, earnings differentials grow larger over the early to middle career and then slow down and begin to converge as they near 50 years of age. For women, earnings differentials emerge later in the career and show no evidence of convergence. Part of the child health earnings differential is accounted for by selection into diminished educational attainment, the earlier onset of chronic disease in adulthood, and, particularly for men, labor force participation.
Keywords: Demographics; Health Conditions and Status; Public Policy

How Does Occupational Status Impact Bridge Job Prevalence - Kevin E. Cahill; Michael D. Giandrea; Joseph F. Quinn; Office of Productivity and Technology (Economic Working Paper, 2011)
Is bridge job prevalence reduced significantly if a change in occupation is required in addition to the hours and tenure requirements that typically define bridge job employment. Prior research has shown that the majority of older Americans with career employment do not exit the labor force directly from their careers. Rather, most career individuals take on a 'bridge job' later in life, that is, a job that follows full-time career (FTC) employment and precedes complete labor force withdrawal (i.e., retirement). One criticism of this finding is that bridge job prevalence may be overstated because the definition of a bridge job in the existing literature does not require a change in occupation. This paper investigates the extent to which bridge jobs involve a change in occupation or a switch to part-time status, both of which may signal retirement transitions as opposed to continued career employment, albeit with a different employer. We use the Health and Retirement Study (HRS), a nationally-representative longitudinal dataset of older Americans that began in 1992 as the basis for our analysis. We find that, among HRS respondents who were on a FTC job at the time of the first interview and who changed jobs in subsequent waves, 48 percent of the men and 40 percent of the women also changed occupations, using 2-digit occupation codes. Further, when hours worked are also considered, we find that more than three quarters of FTC respondents who changed jobs later in life had either a change in occupation or a switch from full-time to part-time status. Finally, an examination of those career workers who changed jobs but not occupations and who remained working full time reveals that, as a whole, they resemble those who took bridge jobs rather than those who remained on their FTC job. We conclude that the vast majority of career workers who changed jobs later in life did in fact do so as part of a retirement transition.
Keywords: Employment and Labor Force; Health Conditions and Status; Methodology; Retirement Planning and Satisfaction

Impact of Health Conditions on Cognitive Change in Later Life: A Cross-Study Comparative Analysis - Sparks, Catharine (University of Victoria (Canada), 2011)
Relatively few studies have considered how changes in health are associated with changes in cognition in aging populations. Even fewer have investigated the similarities and differences of the health-cognition link evidenced across independent longitudinal studies of aging that differ in country and birth cohort. The main objective of the current research is to evaluate aging-related cognitive change in the context of physical health conditions and to compare patterns and synthesize results across several longitudinal studies of aging. This cross-study evaluation is based on data from three longitudinal studies of aging: 1) the OCTO-Twin Study, a longitudinal investigation of same-sex twin pairs drawn from the population-based Swedish Twin Registry (N = 702; 67% female; mean age is 83.5), 2) the Health and Retirement Study (HRS), a study of middle-aged and older adults in the U.S. (N = 21,364; 57% female; mean age is 65.8), and 3) the English Longitudinal Study of Aging (ELSA), a study of middle-aged and older adults in the U.K. (N = 11,397; 54% female; mean age is 65.3). Data were analyzed using latent growth curve (LGC) analysis to evaluate 1) the impact of diagnosed health conditions and 2) the additive impact of comorbidity on level and rate of change in distinct cognitive outcomes. Our findings indicate that particular health conditions significantly impact initial status and rate of change in cognition, but do so differently across longitudinal studies of aging. The argument is made that the inclusion of health in our predictive models is essential as we try to parse out the effects of pathological aging vs. normative age-related change in cognition. The results of this study show the importance of replication in longitudinal research and for contrasting patterns of effects across independent studies in order to build a cumulative basis for further understanding of the dynamics among aging, health, and cognition in populations that differ in cohort, culture, and country.
Keywords: Cross-National; Health Conditions and Status; Methodology; Public Policy

The implications of Alzheimer's Risk for Household Financial Decision Making: Essays on the acquisition of human capital - John Hsu (Department of Economics, 2011)
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction

Individual and Additive Effects of Lifestyle Behaviors on Cognition: A Longitudinal Study - Eisenstein, A. (University of Illinois at Chicago, Health Sciences Center, 2011)
Decreasing the incidence and prevalence of dementia is a national priority. An intervention with the potential to delay the average age of onset of Alzheimer's disease by just one year would greatly reduce the personal and societal costs associated with the disease. The series of proposed studies for this analysis will determine the extent to which a set of modifiable lifestyle behaviors that include physical, social, and cognitive activity, smoking, and alcohol consumption, are associated with multiple measures of cognition. The overall strategy is to examine the individual, interactive, and combined effects of these behaviors on a variety of cognitive outcome measures at 1-year and 7-years post-baseline, using multiple datasets derived from the health and retirement study. The datasets were derived from a sample of N=2037 respondents who completed surveys in 2000, 2001, 2002, and 2008. Demographic and other health status measures will be controlled for. Findings revealed that demographic characteristics had the most consistent association with cognition across outcome measures and across years. Total mental status score was the most sensitive outcome measure of bivariate relations in both the 1-year and 7-year analyses. Lifestyle behaviors at baseline had more significant associations with cognitive scores in the 7-year than the 1-year analyses. Of all the behaviors analyzed, cognitive activity had a significant association with more cognitive outcomes and in more models than any other behavior, followed by alcohol consumption. When controlling for other behaviors, cognitive activity continued to stand out above the others as being a significant predictor of cognitive outcomes. These findings begin to clarify the associations between behavioral risk factors and subsequent cognitive performance among older adults. The findings suggest that a lifestyle including cognitive activity and moderate alcohol consumption, more than any other behavior or a combination of behaviors, may result in promoting cognitive health for both the short-term and long-term. This work highlights the differing conclusions that can be drawn based on the outcome measure use, the time between measurement of predictors and outcomes, and the extent of covariates accounted for.
Keywords: Health Conditions and Status; Healthcare; Public Policy

The Influence of Public Policy on Health, Wealth and Mortality - John Karl Scholz; Ananth Seshadri (Michigan Retirement and Disability Research Center Project, 2011)
In this project we extend an augmented lifecycle model, incorporating a Grossman-style model of health capital, to enhance understanding of factors influencing consumption, wealth and health. We develop three primary results when using the model to explore the effects of stylized versions of Medicare and Social Security on wealth and longevity. First, our model calibration implies consumption and health are complements. As health depreciates with age, households will get less utility from consumption than would be in the case of a lifecycle model that does not endogenize health. Second, it appears that forward-looking households, when confronted by a substantially reduced safety net, will respond by reducing consumption and by reducing their health investment and therefore longevity. Third, there is a potentially important difference between short- and long- run responses to policy.
Keywords: Consumption and Savings; Event History/Life Cycle; Health Conditions and Status; Net Worth and Assets; Public Policy

Intrinsic Rewards of Work, Future Time Perspective, the Economy in the Future and Retirement Planning - Ting-Ying Yang; DeVaney, Sharon A. (The Journal of Consumer Affairs, 2011)
This study incorporated intrinsic rewards of work, future time perspective and perspective on the economy in the future to create a model for the psychological mechanism of planning for retirement. The data set included those who were not retired (N = 2,266) in the 1992 Health and Retirement Study. Confirmatory factor analyses and structural equation modeling were used. The analyses were conducted separately on the different types of retirement plans. The results suggest that human resource professionals should (1) encourage employees who perceive high intrinsic rewards of work to plan for their retirement, and (2) remind employees that retirement might be closer than they anticipate. PUBLICATION ABSTRACT
Keywords: Health Conditions and Status; Methodology; Other; Retirement Planning and Satisfaction

Links Between Biomarkers and Mortality - Eileen M. Crimmins; Vasunilashorn, Sarinnapha (International Handbook of Adult Mortality, 2011)
A biomarker is an objectively measured indicator of a physiological state. Biomarkers include indicators of genotype, normal biological processes, pathogenic processes, and pharmacologic responses to a therapeutic intervention (Biomarkers Definitions Working Group 2001; National Heart Lung and Blood Institute 2007). Biomarkers can serve as objective indicators of health status within a sample, indicators of health change over time, and, with comparable measurement, indicators of differences across populations. They signal disease status, early physiological dysregulation preceding disease, or change in organ reserve or functioning. And they can clarify how the social, psychological, and behavioral factors traditionally examined in social science research get under the skin to influence biology and subsequent health outcomes (Crimmins and Seeman 2001, 2004; Crimmins et al. 2008a; Seeman and Crimmins 2001).
Keywords: Demographics; Health Conditions and Status; Healthcare

Modeling social participation as predictive of life satisfaction and social connectedness: Scale or index? - Zelenka, Anne T. (University of Denver, 2011)
Social participation in late adulthood through activities such as volunteering with charities, playing sports, and joining clubs can increase life satisfaction, directly by providing enjoyable engagement and indirectly by increasing a person's sense of social connectedness. When reported levels of different types of activities are used to measure social participation, conventional measure development procedures based on classical test theory lead to a proliferation of small participation subscales that don't show good reliability, don't have theoretical power, and don't match researchers' conceptions of the dimensions of participation. Based on the poor performance of conventional approaches, some researchers have suggested that social participation should be modeled as an index composed of its indicators rather than as a scale in which indicators reflect an underlying latent factor. Typical approaches in psychosocial research rely on reflective-indicator models, which correspond to scale development, rather than incorporating composite variables with causal indicators. The latter approach, where manifest indicators are specified as causing the unobserved construct, is sometimes known as formative measurement , since the construct of interest is formed by its indicators. This study compared a scale model of social participation based on reflective measurement to an index model based on formative measurement. Using a sample representative of community-dwelling U.S. adults over age 65 from the Health and Retirement Study's 2008 wave of data collection, two alternative measurement models of participation were constructed using sixteen items that recorded frequency of participation in different activities. Because patterns of participation differed for males and females, gender-specific models were developed. The scale models assigned participation items to subscales based on item intercorrelations. The index model assigned items to participation composites based on predictive associations with the outcomes of social connectedness and life satisfaction. The index construction process led to a unidimensional representation of participation, composed of six of the original sixteen participation activity items. The initial attempts to build a scale model led to structures with many small factors and poor predictive validity. Based on the findings of unidimensionality for the index model, a single-factor scale model was explored for female respondents only. Results showed that both index and scale approaches have the potential to produce participation models that are parsimonious, well-fitting, and externally valid even though conventional scale development rules-of-thumb and current conceptions of the domains of participation lead the researcher to non-parsimonious, poorly-fitting solutions lacking predictive capability. Participation measurement instrument developers often theorize the existence of three or more dimensions of participation. Whether they use conventional (reflective indicator) or more radical (formative indicator) models, they are advised, based on this study's results, to evaluate a single-dimensional structure among their candidate models.
Keywords: Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction

Net Worth Accumulation by Different Quintiles of Older Adults Approaching Retirement Age and 10 Years Later - Martha N. Ozawa; Yeo, Yeong H. (Journal of Sociology and Social Welfare, 2011)
The shift in responsibility for income security from the government to individuals makes the accumulation of net worth a vital issue. We investigated the rate of net worth accumulation for people aged 51 to 61 in 1991 (N=7,544) and 61 to 71 in 2001 (N=5,711) using the RAND Health and Retirement Study. We found that the rate of net worth accumulation by the fifth (top) quintile was extremely high in 1991, and the distribution of net worth became more skewed in favor of the wealthy in 2001. Older adults in the first and second quintiles are unable to face the challenge of the shift in responsibility for income security from the government to individuals. Adapted from the source document.
Keywords: Demographics; Health Conditions and Status; Income; Net Worth and Assets; Retirement Planning and Satisfaction

Nursing Home Stays and the Pace of Severe Disability Onset - Kenzie Latham (Research on Aging, 2011)
Severe disability is an important predictor of nursing home admissions. The purpose of this study is to examine the role of severe disability pacing on risk of short- and long-term nursing home stays. Respondents who developed severe disability were assigned into one of two pacing trajectories: catastrophic or progressive disability. The author analyzed seven waves of data from the Health and Retirement Study and created a series of discrete-time event history models. The analysis showed that the risk associated with severe disability and nursing home stays varied based on severe disability pacing. Progressive and catastrophic disability were associated with increased risk of short- and long-term stays; however, the risk of nursing home stays was much greater for respondents with catastrophic disability for short- and long-term stays. The findings have implications for policy and research. The author suggests that future research focus on interventions aimed at slowing the pace of severe disability. PUBLICATION ABSTRACT
Keywords: Disabilities; Health Conditions and Status; Healthcare; Public Policy

Personality and Response to the Financial Crisis - Angela Lee Duckworth; David R Weir (Michigan Retirement and Disability Research Center Working Paper, 2011)
In a previous study, we found the family of personality traits known as conscientiousness to be associated in cross-sectional analyses with both lifetime earnings and wealth. In this study, we used data from an Internet survey of HRS respondents in the second quarter of 2009 to test whether conscientiousness and other Big Five factors prospectively predicted responses to the financial crisis of 2008/09. In addition, to improve the targeting and design of behavioral interventions for at-risk individuals, we examined two specific facets of conscientiousness (i.e., self-control and perseverance) that may be more highly related to these economic outcomes than other facets. Finally, we used data from the Consumption and Activities Mail Survey (CAMS) to examine whether personality is related to the proportion of income saved vs. spent. Missing data precluded sufficiently powerful prospective analyses of personality and responses to the financial crisis. Likewise, data on self-control and perseverance from the 2010 experimental module were not sufficient at the time of final reporting to come to definitive conclusions about how these facets relate to economic outcomes. We did find that conscientious adults save more and spend less of their incomes, whereas adults who are higher in openness to experience (e.g., adventurous, sophisticated) save less and spend more of their income. The robust associations between conscientiousness and economic outcomes suggests further investigation of interventions that improve conscientiousness as well as policies that specifically target less conscientious individuals (e.g., default choices for retirement savings).
Keywords: Health Conditions and Status; Net Worth and Assets; Public Policy

Potential Enhancements to Data on Health Insurance, Health Services, and Medicare in the Health and Retirement Study - John Z. Ayanian; Meara, Ellen; J. Michael McWilliams (Forum for Health Economics and Policy, 2011)
As a nationally representative cohort of middle-aged and elderly adults with longitudinal data spanning nearly two decades, the Health and Retirement Study (HRS) is an important resource for researchers studying the dynamics of health insurance coverage in the United States and the relation of insurance coverage to the use of health services and to health outcomes. We assessed the strengths and limitations of currently available HRS data for such research, focusing on survey items in these domains and Medicare claims data that have been linked to HRS survey data. The process for researchers to obtain Medicare claims has greatly improved in recent years. The additions of biomarkers (e.g. blood pressure and serum cholesterol) and objective measures of physical functioning for HRS participants have also been notable improvements. We propose changes to the HRS to enhance its value for health services research, particularly regarding the effects of health care reform as the Patient Protection and Affordable Care Act of 2010 is implemented over the next decade.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Methodology

Psychosocial determinants of diabetic control and satisfaction with diabetes care - Dzivakwe, V. (University of North Texas, 2011)
Diabetes mellitus affects 7.8% of the American population. National health statistic data and other research shows that racial/ethnic disparities exist in terms of prevalence and treatment outcomes. The present study investigated the role of patient health beliefs (i.e., locus of control, self-efficacy) and the doctor-patient relationship (e.g., satisfaction and collaboration with health care provider), as relative predictors of diabetic control (i.e., HbA1c levels) and overall satisfaction with diabetes care, in older adult participants with diabetes. Demographic, psychosocial, and diabetes-related data from the Health and Retirement Study (HRS) 2003 Diabetes Study were analyzed to compare treatment outcomes among non-Hispanic White, non-Hispanic Black, and Hispanic individuals with various types of diabetes. Non-Hispanic White individuals exhibited better diabetic control than their minority counterparts ( F (2, 592) = 7.60, p < .001); however, no significant group differences were noted in terms of psychosocial factors. Diabetic control was best predicted by time since diagnosis (² = -.21, p < .001), satisfaction with diabetes self-care (² = .19, p < .001) and age (² = .12, p < .01). In addition, satisfaction with provider care was best predicted by perceived collaboration with provider (² = .44, p < .001), satisfaction with diabetes self-care (² = .22, p < .001) and diabetes self-efficacy (² = .08, p < .05). Recommendations for future research were discussed.
Keywords: Demographics; Health Conditions and Status; Healthcare; Public Policy; Women and Minorities

A Rationale for Including a Brief Assessment of Hedonic Well-being in Large-scale Surveys - Arthur A. Stone (Forum for Health Economics and Policy, 2011)
Subjective well-being is comprised of both evaluative (life satisfaction) and hedonic (affect) components, and there has been a call to include both aspects of well-being in large-scale surveys. This paper presents a rationale for the feasibility of including a brief measure hedonic well-being based on the measurement of yesterday s affect and experience. It discusses issues of the distinctiveness of hedonic well-being from life satisfaction, the sensitivity of a single day s affect, the sample sizes required for detecting group differences, and the experiential content that could also be collected to extend the value of affective reports. I conclude that a brief assessment is feasible and, in conjunction with measures of evaluative well-being, could add to our understanding of well-being in populations.
Keywords: Health Conditions and Status; Methodology; Retirement Planning and Satisfaction

Results from the Health and Retirement Study Biomarker Validation Project - Eileen M. Crimmins; Jung K Kim; Heather McCreath; Teresa Seeman (Ann Arbor, The University of Michigan, 2011)
Keywords: Health Conditions and Status; Methodology

The role of home environments in residential adjustment decision making in later life - Stoeckel, Kimberly J. (University of Massachusetts, Boston, 2011)
Using the nationally representative Health and Retirement Study, this research explored the multi-faceted influence of the accessibility of housing environments on the occurrence and characteristics of residential adjustments made by older adults aged 70 or older. A range of housing adjustment outcomes were examined, including home modifications and relocation into age-segregated senior housing. Analysis of the accessibility gains following relocation was also included in the empirical analyses. The Ecological Theory of Aging (Lawton & Nahemow, 1973) provided the conceptual framework for the research. The longitudinal design of the HRS empirically advanced understanding of the key theoretical constructs by sensitizing the results to how change in competency and how competency uniquely intersects with housing environment in later life. The analyses findings suggested that structural supportive environmental features in homes, such as wheelchair accessibility, reduce the odds of making subsequent housing adjustments. Declines in physical competency and negative person-environment encounters were shown to be predictive of increased risk of housing adjustment. However, the preference of older adults to age in place was underscored by the findings showing that home modification rather than relocation was predicted by greater person-environment misfit. Age-segregated senior housing moves were not found to be influenced by the built environment of prior homes, but more so by spouse competency and household financial wealth. Moves that resulted in gains in accessibility features were also predicted by greater levels of person-environment misfit. The person-environment misfit variable, introduced in this study as an exploratory methodological advance, highlighted the heterogeneous nature of older adults in their interactions with the built home environments. The analyses findings revealed that it is the unique intersection of competency and the built environment for each individual that has the greatest impact on subsequent housing adjustments made in later life. This research provides empirical backing for policy advocates seeking to promote universal design and visitability standards for housing as a way to support successful aging in place within the aging population.
Keywords: Health Conditions and Status

The roles of self and society in the relationship between physical health, self-perception of aging, and depressive symptoms in later life - Jina Han (The Ohio State University, 2011)
Possibilities for increased morbidity in physical health in later life have been continuously discussed as important factors that can affect psychological well-being of older people. In addition, perceived emotional support has been widely examined as a protective source against depressive symptoms in later life. However, potential roles of self-perception of aging (one's own age stereotypes) that might be related to physical health, perceived emotional support, and depressive symptoms have been rarely studied. Furthermore, although there has been considerable interest in examining influence of self-perception of aging on physical and cognitive functioning of older individuals, the influence of self-perception of aging on mental health has not been widely studied. Since cognition can influence behavior and emotion, self-perception of aging can be an important cognitive predisposition of depressive symptoms of older individuals. Stereotype embodiment theory and the buffer theory of social support have suggested that age stereotypes and perceived emotional support can affect the construction of self-perception of aging in later life. However, little research has explored in an integrated manner about how self-perception of aging is related to both a discouraging societal impact on the self as constructing age schema and a protective role of the self through perceived emotional support in the aging process. In order to address the gaps in the literature, the current study aimed to achieve three goals: (1) to examine the mediating effect of self-perception of aging between physical health and depressive symptoms; (2) to test the moderating effect of age schema on the relationship between physical health and self-perception of aging; and (3) to estimate the moderating effect of perceived emotional support on the relationship between physical health and self-perception of aging. Physical health status was hypothesized to have an impact on depressive symptoms and to be mediated through self-perception of aging. Older individuals having age schema were expected to have more negative self-perception of aging than those without age schema under similar physical health conditions. Also, perceived emotional support was expected to moderate the relationship between physical health status and self-perception of aging. The study used a sample of 1240 community-dwelling older individuals aged 50 and over who participated in the leave-behind surveys from the 2004 and 2008 surveys of the Health and Retirement Study. Data were analyzed using Structural Equation Modeling. The results provided strong evidence for the mediating effect of self-perception of aging in the relationship between physical health and depressive symptoms. To a lesser extent, the moderating effect of age schema was supported; older individuals who had age schema were more likely to report negative self-perception of aging four years later than older individuals without age schema under the same physical health conditions. Although there was a significant main effect of perceived emotional support on self-perception of aging, no evidence was found for the interaction effect of perceived emotional support with physical health in predicting self-perception of aging. Study limitations and implications for future research and practice were discussed.
Keywords: Health Conditions and Status; Healthcare

Self Assessed Health, Anchoring Vignettes, and Unobserved Heterogeneity in the Health and Retirement Study - Noroski, Paul J. (Economics, 2011)
This dissertation examines the subtleties inherent to socioeconomic models of health. The relative contributions of unobserved heterogeneity and state dependence in explaining the dynamics of health in the U.S. are controlled for as the average partial effects of socioeconomic status are estimated. In addition to these investigations, I use anchoring vignette data from the Health and Retirement Study to investigate health perceptions in the U.S. and how they affect the comparability of self assessments of health across the population. The results imply that just over 30% of the unexplained variation in self-assessed health is attributable to unobserved heterogeneity in the form of a time invariant individual effect. Although attrition bias is detected in the panel, estimates obtained using an inverse probability weighted specification reveal that attrition has virtually no effect on the estimated relationships between health and socioeconomic status. Regarding the vignette analyses, many of the characteristics that affect health status are also found to affect perceptions of health. For example, I find that respondents in lower income groups tend to be more tolerant of mental health problems than the rest of the population and that recipients of federal disability insurance may be more likely to rate a given health problem as being disabling. Upon identifying which personal characteristics influence reporting behavior, I estimate models of self-reported health that enhance comparability of survey responses across the population. I find that failing to account for reporting heterogeneity ultimately leads to a distortion of the estimated relationships between health and socioeconomic status.
Keywords: Demographics; Disabilities; Health Conditions and Status; Methodology

Social Connectedness in Health, Morbidity and Mortality, and Health Care The Contributions, Limits and Further Potential of Health and Retirement Study - Pescosolido, Bernice (Forum for Health Economics and Policy, 2011)
This part of the mid-term review of the Health and Retirement Study (HRS) provides an overall assessment of the utility of HRS data for research targeting the nature and influence of social connectedness. As one of the major dimensions of the social aspects of psychosocial influences, social connectedness is among the most complicated in terms of definition, conceptualization, and measurement. However, the century-long body of theory and findings couple with a recent resurgence of research on the critical impact of these ties for health, illness, and health care to call for an examination of the richness in and limitations of current HRS data. This assessment is comprised of three broad steps: 1) an overview of the nature of social connectedness, and of the dimensions and methodological approaches that can and have been used in studying health, health care, and aging; 2) the range, strengths and limitations of the HRS data on each approach; and 3) suggestions for potential directions to increase the utility of data collected and further research contributions from the HRS. While no tabular listing of items relevant to social connectedness is presented, the sets of items that tap this notion are referenced throughout. Overall, the HRS represents one of, if not the most impressive data sets regarding the ability to examine the influence of social connectedness on health, illness and health care. Given different theoretical and methodological traditions of social connectedness (e.g., the local or ego-centered perspective; social support perspective; social capital perspective; Pescosolido 2006a), the HRS either currently offers a way to tap into various views of social connectedness or holds the potential to do so. Specifically, the HRS includes four kinds of social connectedness data: socio-demographic proxies that represent a tie (e.g., marital status) with detailed data on the nature of the bond; social support batteries which offer respondent perceptions of the overall positive and negative aspects of sets of relationships; eco-centric tie data, which provide a list of names or roles that can provide support (i.e. latent ties); and networks of event response in which respondents list individuals who were called upon (e.g., activated ties) under certain conditions. Given the individually-based and national scope of the HRS, the collection of full or complete network data is not feasible at present. Four strategies could improve the collection and use of social connectedness data in the HRS. First, data collection sections that are explicit or implicit ego-centric name generators or activated ties lists could be expanded and refined to provide more complete data. Under the looping structure of the HRS, both the ego-centric and event response batteries can serve as a foundation for expanded network batteries. Second, given the increasing role of social media in contemporary American lives, the HRS section on the use of technology should be reviewed and expanded to tap into virtual ties. Third, locator data designed to improve follow-up of the HRS samples can form the basis of a network roster and for analyses of the dynamics of ties and its influence on health and health care. Fourth, while it is not possible to go back and recapture data about social connectedness, a sub study which targets the named social convoy over a person s life (defined only as time in the HRS) would provide invaluable data that could not be collected from any other existing study. That is, while subject to a variety of criticism (e.g., telescoping effects), the ability to collect data on extent of turnover and the reasons for shifts in social connectedness would allow an analysis of the impact of social network dynamics in later life, potentially reveal key turning points in social network support, and offer targeted points of interventions for fostering the social connectedness that has, to date, been shown (in the HRS and other studies) to be so essential to health and well-being.
Keywords: Health Conditions and Status; Methodology

The State and Future of Blood-Based Biomarkers in the Health and Retirement Study - Thomas W McDade (Forum for Health Economics and Policy, 2011)
The Health and Retirement Study (HRS) is an important national resource for policy makers and investigators across a wide range of disciplines, and it is critical that the study collects the best information possible on the health status of its participants within the constraints of the survey design, and without compromising the integrity of the sample. Potential directions for the collection and analysis of biomarker data in future waves of HRS are discussed, with a primary focus on blood-based biomarkers. Advantages and disadvantages of various methods for collecting blood in the home are considered, with particular attention given to the strengths and weaknesses of dried blood spot (DBS) sampling. DBS sampling has been widely applied in recent biosocial surveys due to the low cost and burden associated with sample collection, but these benefits need to be weighed against challenges associated with quantification in the laboratory. Attention is also given to additional biomarkers that may be of relevance to HRS, and that would expand the survey s current focus on obesity and metabolic syndrome. Measures of inflammation, pathogen exposure, reproductive function, stress, and epigenetic modifications are suggested as potentially productive future directions for the study. In addition, the analysis concludes with the following recommendations for HRS: Continue to collect DBS samples, but consider alternatives; implement enhanced procedures for quality control; calibrate DBS results against plasma values, and invest in methods development.
Keywords: Health Conditions and Status; Methodology

Subjective Health Assessments And Active Labor Market Participation Of Older Men: Evidence From A Semiparametric Binary Choice Model With Nonadditive Correlated Individual-Specific Effects - Jürgen Maurer; Roger Klein; Francis Vella (The Review of Economics and Statistics, 2011)
We use panel data from the U.S. Health and Retirement Study, 1992-2002, to estimate the effect of self-assessed health limitations on the active labor market participation of older men. Self-assessments of health are likely to be endogenous to labor supply due to justification bias and individual-specific heterogeneity in subjective evaluations. We address both concerns. We propose a semiparametric binary choice procedure that incorporates nonadditive correlated individual-specific effects. Our estimation strategy identifies and estimates the average partial effects of health and functioning on labor market participation. The results indicate that poor health plays a major role in labor market exit decisions. PUBLICATION ABSTRACT
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Methodology; Other

Successful Aging and Obesity: Social and Developmental Heterogeneity in Trajectories of Body Weight from Middle to Older Ages - Anda Botoseneanu (University of Michigan, 2011)
Obesity is increasingly prevalent among older adults, yet little is known about the distribution of long-term trajectories of body-weight in this age group. The three essays included in this dissertation aim to depict the trajectories of body-mass index (BMI) from middle to old age and to examine social and behavioral variations in these trajectories. Eight waves (1992-2006) of the Health and Retirement Study involving a nationally representative cohort of Americans aged 51 to 61 years at baseline were used. Changes in BMI were analyzed using alternatively hierarchical linear modeling or semiparametric mixture modeling, with adjustment for time-constant and time-varying covariates. First study finds that over 14 years, respondents followed a linearly increasing BMI trajectory. Compared with Caucasians, African-Americans had higher BMI levels, while Hispanics had similar BMI levels, but lower rates of increase over time. Higher education predicted lower BMI levels and was not associated with the rate of change. Older age-at-baseline predicted lower BMI levels and lower rates of increase. No gender differences were found. The second study shows that smoking and vigorous physical activity (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and physical activity resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased during the study period, while the strength of association between BMI trajectories and PA or alcohol use were constant. In the third study, five distinct BMI trajectories are identified, differing primarily in their intercept: normal BMI trajectory (19.9% of sample), overweight (43.8%), borderline-obese (25.4%), obese (8.9%), and morbidly-obese (2.1%). Each trajectory showed an upward trend over the study period, although the rate-ofincrease varied between trajectories. Compared with Whites, Blacks and Hispanics had greater probabilities of membership in the higher BMI trajectory groups. Females had approximately half the risk of following the overweight and obese BMI trajectories compared with males. In conclusion, significant racial/ethnic, gender and educational heterogeneity in BMI trajectories exists in older adults. Health behaviors provide beneficial modifications in BMI trajectories. Tailoring of public health and clinical interventions to trajectory group characteristics may reduce obesity-related health disparities in aging.
Keywords: Health Conditions and Status; Healthcare; Women and Minorities

Taking Early Retirement May Retire Memory, Too - Gina Kolata (New York Times, 2011)
While not everyone is convinced by the new analysis, published recently in The Journal of Economic Perspectives, a number of leading researchers say the study is, at least, a tantalizing bit of evidence for a hypothesis that is widely believed but surprisingly difficult to demonstrate. [...] they note, that could be because people whose memories and thinking skills are declining may be more likely to retire than people whose cognitive skills remain sharp. [...] research has failed to support the premise that mastering things like memory exercises, crossword puzzles and games like Sudoku carry over into real life, improving overall functioning. [This article references the 2010 JEP paper by Rohwedder and Willis which argues that "early retirement appears to have a significant negative impact on the cognitive ability of people in their early 60s".]
Keywords: Cross-National; Health Conditions and Status; Retirement Planning and Satisfaction

Three essays on socioeconomic status, social support, and the Health and Retirement Study - Allison R Sullivan (University of Pennsylvania, 2011)
The associations between both socioeconomic status and mortality and social support and mortality are widely recognized, though the mechanisms that underlie these associations are less well understood. The Health and Retirement Study allows for a rich exploration of these associations. In the first essay, I investigate mortality differentials by both education and household wealth, first for all causes combined and then over seven different causes of death. Both education and wealth are strongly associated with mortality. I find that the SES gradient is strongest for lung cancer and respiratory diseases, and the gradient is weakest for cancers other than lung and cerebrovascular diseases. In the second essay, I explore how mortality risk increases upon becoming widowed, and what factors increase or mitigate that change in risk. I find that becoming widowed is associated with a nearly 50% increase in mortality risk, net of demographic controls. Some evidence indicates that this risk increase may be due to consequences of adjusting to a new living environment, although some is certainly due to selection into widowhood. Factors that mitigated widowhood mortality risk included education and wealth; children did not have an association with widowhood mortality risk. A spouse may be an irreplaceable source of support. In the third essay, I explore mortality differentials by religion. I find that substantial differences exist, with Mainline Protestants and Jews having the most favorable mortality. Differences were partially explained by socioeconomic status. While Catholics, evangelical Protestants, and black Protestants benefit from favorable attendance patterns, attendance (or lack of) at services explains much of the higher mortality of those with no religious preference. Health behaviors do not mediate the relationship between mortality and religion, except among evangelical Protestants.
Keywords: Adult children; Demographics; Health Conditions and Status; Net Worth and Assets

Trajectories of alcohol consumption among the elderly widowed population: A semi-parametric, group-based modeling approach - Hui-Peng Liew (Advances in Life Course Research, 2011)
Even though research on the use, misuse, and abuse of alcohol among the elderly has burgeoned in recent decades (see reviews by Johnson, 2000 , Kirchner et al., 2007 and Patterson and Jeste, 1999 ), only a few empirical studies have explored the post-bereavement alcohol consumption trajectories among the elderly widowed population. To fill this research gap, this study aims to examine the temporal processes underlying the relationship between widowhood and subsequent drinking behaviors among the elderly widowed population and to examine the potential predictors of these trajectories. The empirical work of this study is based on longitudinal data from the 1992 to 2008 Health and Retirement Study (HRS). A semi-parametric mixture model (SPMM) is used to estimate the distinctive trajectories of post-bereavement alcohol consumption. Results reveal that the type of drinking trajectory that characterize the post-bereavement drinking behavior of an individual is largely dependent upon the characteristics of the individuals (e.g. gender), the health conditions and health behavior of deceased spouse, pre-bereavement alcohol consumption, and depression. Another important finding is that bereaved men seem to have greater difficulty overcoming the transitional burden associated with widowhood. Copyright Elsevier Ltd.
Keywords: Demographics; Health Conditions and Status; Healthcare; Net Worth and Assets

Accessibility of the residential environment: Its influence on the depressive symptoms of older adults - Guzzardo, Mariana T. (University of Connecticut, 2010)
As people age, a supportive and accessible environment becomes more salient in the face of declining functional capacity. Whereas past research supports a relationship between residential environment and well-being, few studies have focused on the specific relationship between the accessibility of the home and mental health. The purpose of the present study is to examine the influence of barrier-free/accessible features in the home on elderly individuals' depressive symptoms, when they experience difficulty with activities of daily living. The barrier-free/accessible features that are investigated include: ramps, railings, wheelchair modifications, grab bars, shower seats and call devices. This study uses data products distributed by the RAND Corporation, based on the 2006 wave of the Health and Retirement Study. The analytic procedures are divided into three parts. In the first place, descriptive analyses were conducted, including independent sample t -tests. These analyses served the purpose of examining differences between key groups within the sample (ethnic group comparisons, and comparisons between senior housing residents and non-senior housing residents). In the second place, hierarchical multiple regression analyses were conducted to examine the features of the home as predictors of depressive symptoms, after controlling for difficulty with ADLs, and various socio-demographic variables. In the third place, the main purpose of the present study was to test the influence of the residential environment on depressive symptoms through a structural regression (SR) model, using Structural Equation Modeling. The model contains functional impairment as a mediator, while age, income, education, gender, and living arrangement function as exogenous variables. Overall, results provide support for the hypothesized model. Findings suggest that accessible dimensions of the physical environment can contribute to psychological well-being by playing a compensatory or assistive role and meeting the individuals' functional needs.
Keywords: Consumption and Savings; Demographics; Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction

Accurately Measuring Health Over the Life Course - Lange, Fabian; McKee, Douglas (Center for Retirement Research at Boston College Working Papers, 2010)
This paper develops a new method of estimating rich, dynamic models of health based on multiple health measures available in the HRS. We apply these methods to investigate what generates the large socioeconomic gradient in health. Preliminary results suggest a large role for initial differences in health at age 50 that persist into old age.
Keywords: Health Conditions and Status; Meta-analyses; Mortality; Older Adults

The Asset Cost of Poor Health - James M. Poterba; Steven F Venti; David A Wise (NBER Working Paper, 2010)
This paper examines the correlation between poor health and asset accumulation for households in the first nine waves of the Health and Retirement Survey. Rather than enumerating the specific costs of poor health, such as out of pocket medical expenses or lost earnings, we estimate how the evolution of household assets is related to poor health. We construct a simple measure of health status based on the first principal component of HRS survey responses on self-reported health status, diagnoses, ADLs, IADL, and other indicators of underlying health. Our estimates suggest large and substantively important correlations between poor health and asset accumulation. We compare persons in each 1992 asset quintile who were in the top third of the 1992 distribution of latent health with those in the same 1992 asset quintile who were in the bottom third of the latent health distribution. By 2008, those in the top third of the health distribution had accumulated, on average, more than 50 percent more assets than those in the bottom third of the health distribution. This asset cost of poor health appears to be larger for persons with substantial 1992 asset balances than for those with lower balances.
Keywords: Health Conditions and Status; Net Worth and Assets

The association of earnings with health in middle age: Do self-reported earnings for the previous year tell the whole story? - David Rehkopf; Jencks, Christopher; M. Maria Glymour (Social Science and Medicine, 2010)
Research on earnings and health frequently relies on self-reported earnings (SRE) for a single year, despite repeated criticism of this measure. We use 31 years (1961-1991) of earnings recorded by the United States Social Security Administration (SSA) to predict the 1992 prevalence of disability, diabetes, stroke, heart disease, cancer, depression and death by 2002 in a subset of Health and Retirement Study participants (n = 5951). We compare odds ratios (ORs) for each health outcome associated with self-reported or administratively recorded earnings. Individuals with no 1991 SSA earnings had worse health in multiple domains than those with positive earnings. However, this association diminished as the time lag between earnings and health increased, so that the absence of earnings before approximately 1975 did not predict health in 1992. Among those with positive earnings, lengthening the lag between SSA earnings and health did not significantly diminish the magnitude of the association with diabetes, heart disease, stroke, or death. Longer lags did reduce but did not eliminate the association between earnings and both disability and depression. Despite theoretical limitations of single year SRE, there were no statistically significant differences between the ORs estimated with single-year SRE and those estimated with a 31-year average of SSA earnings. For example, a one unit increase in logged SRE for 1991 predicted a 19 reduction in the odds of dying by 2002 (OR = 0.81; 95 confidence interval: 0.72,0.90), while a similar increase in average SSA earnings for 1961-1991 had an OR of 0.72 (0.6,0.82). The point estimates for the OR associated with 31 year average SSA earnings were further from the null than the ORs associated with single year SRE for heart disease, depression, and death, and closer to the null for disability, diabetes, and stroke, but none of these differences was statistically significant.
Keywords: Health Conditions and Status; Healthcare; Income; Social Security

Changes in the prevalence of cognitive impairment among older Americans, 1993--2004: Overall trends and differences by race/ethnicity and socioeconomic status - Kristen M. H. Sheffield (Medical Branch Graduate School of Biomedical Sciences, 2010)
Research indicates that the health of the older population in the United States, as measured by most dimensions, has improved over the past two decades. Population-level changes in health have been attributed to increases in education and income and improvements in the treatment and control of disease. Recent research suggests that rates of cognitive impairment have declined as well; however, results have been inconsistent and most studies have included only two time points in the analysis. This project used data from six waves of the Health and Retirement Study to achieve the following aims: (1) determine if the prevalence of cognitive impairment among older adults declined from 1993 to 2004, and (2) determine if the pattern of change in cognitive impairment was consistent across racial/ethnic and socioeconomic groups. Analyses investigated whether changes in demographic, socioeconomic, and health status and behavior variables contributed to overall and group-specific trends. Sampling weights applied to each wave of data enabled merged waves to represent comparable cross-sections of the community-dwelling older population in the United States in each respective year of study. Logistic regression analyses employing cognitive impairment as the dependent variable and a time trend variable as the key independent variable were used to analyze trends. Results showed an annual decline in the prevalence of cognitive impairment of -3.4% per year, adjusting for changes in the age and gender distributions of the population as well as prior test exposure. Increases in educational attainment in the population accounted for the trend. Racial/ethnic and socioeconomic disparities in the prevalence of cognitive impairment decreased considerably between 1993 and 2004. Declines in the prevalence of cognitive impairment were greater for blacks and Hispanics compared to whites and for lower education and wealth groups compared to more advantaged groups. Overall and group-specific trends did not appear to be due to selection bias resulting from changes in rates of mortality or attrition of HRS respondents over time. Improvements in the socioeconomic status of the population have contributed to declines in the prevalence of cognitive impairment among older adults--particularly blacks and Hispanics--in the United States.
Keywords: Demographics; Health Conditions and Status; Women and Minorities

Chronic Health Problems and Depressive Symptoms among Older Women in the U.S - Lee, Yoon G.; Susan L. Brown (Hallym International Journal of Aging, 2010)
Using data from the 2004 Health and Retirement Study (HRS), this study looked at the role of chronic health problems in perpetuating depressive symptoms and investigated socio-economic factors associated with the levels of depressive symptoms for older women aged 65 and above. As expected, chronic health problems were significantly related to the levels of depressive symptoms among older women. This study concludes that more chronic diseases and poorer perceived physical health affected higher levels of depressive symptoms for elderly women. In addition, the findings of this study suggest that having lower levels of wealth, being non-married, and having less education were significant predictors of higher levels of depressive symptoms among older women. Keywords: chronic diseases, depression, population aging, women. Adapted from the source document.
Keywords: Demographics; Health Conditions and Status; Women and Minorities

Cognitive Ability and Retiree Health Care Expenditure - Fang, Hanming; Lauren Hersch Nicholas; Daniel S. Silverman (Ann Arbor, The University of Michigan, 2010)
Prior research indicates that retirees with less cognitive ability are at greater financial risk because they have lower incomes yet higher medical expenditures. Linking HRS data to administrative records, we evaluate two hypotheses about why this group spends more on health: (1) they are in worse health; (2) they receive more expensive or less effective care for the same conditions. We find that the bulk, but not all, of the cross-sectional relationship can be attributed to the poorer health of those with lower cognitive functioning. Much of this relationship appears to be driven by coincident declines in cognitive ability and health. While, in this respect, the data have important limitations, we find no evidence of substantial differences in care, conditional on observable health.
Keywords: Demographics; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance

The demand for preventive activities among older adults and its association with Medicare expenditures - Puig de la Parra, Andrea (University of Pennsylvania, 2010)
In recent years, certain health policy makers have emphasized the need for an increase in preventive services interventions as means to improve health outcomes and cut health care costs. Oftentimes, the debate around the purported benefits of prevention centers on the need to cut the costs of highly costly systems such as Medicare. However, little is known about the factors that might actually influence the demand for preventive services among older adults, neither do we know much about how the dynamic for the demand for prevention plays out among older adults within the context of a household. Moreover, there is little evidence to support the belief that all preventive activities necessarily translate in cost savings. This dissertation examines the theoretical and empirical factors that influence the demand for prevention at the individual and household level. It also analyzes the associations between a diverse set of preventive services and Medicare expenditures in older adults. Using a panel data set from the Health and Retirement study linked to Medicare claims data, I find evidence that while lifestyle prevention such as physical activity, non-smoking and normal weight status maintenance are negatively associated with Medicare expenditures at ages 65-69, clinical preventive activities such as flu shot, cholesterol screening, mammography, Pap smears test and prostate cancer screening have at best no effect on expenditures, at worst they are positively associated; yet these findings may be biased due to uncontrolled unobservables. Also, I find that education, risk aversion, and long term planning are significantly associated with a higher demand for all preventive services. Finally, I find large bargaining effects between household members whereby spouses initiate and terminate preventive activities together. This result leaves room for policy makers to take advantage of spillover effects in the design of interventions designed with the purpose of increasing the demand for prevention.
Keywords: Consumption and Savings; Demographics; Health Conditions and Status; Medicare/Medicaid/Health Insurance

Determinants and Implications of Mortality Risk at the End of the Life Cycle - Edwin S. Wong (University of Washington, 2010)
The primary goal of this dissertation is to investigate the impacts of survival uncertainty on outcomes relevant to older Americans. While objective measures of life expectancy are useful in explaining economic outcomes, this dissertation also highlights the importance of subjective measures. In particular, results suggest survival beliefs provide otherwise unobservable information that better predict outcomes. Chapter one employs a Life Cycle model, showing that households smooth consumption and labor supply. Specifically, a longer expected lifetime is associated with the delay of consumption into the future and substitution of hours worked to the present. The second chapter develops a model for purchases of life insurance by older households and tests for the presence of marital bargaining power. Results indicate that increasing the relative bargaining power of the husband reduces the size of the insurance policy taken against the husband's life, and increases insurance taken on his wife's life. In other words, the household reallocates resources to states of nature that the husband places greater weight, and purchases insurance to guarantee adequate resources for funding optimal consumption in the event of the wife's death. Furthermore, results show systematic differences in the effect of survival uncertainty on life insurance purchases. In particular, life insurance purchases are decreasing with objective survival probabilities, but are increasing with subjective measures, suggesting the presence of asymmetric information. The secondary goal of this dissertation is to extend the literature examining the determinants of adult mortality. The third chapter examines the impacts of family characteristics such as parental and sibling on adult mortality at the objective level using survey data from the Health and Retirement Study. Using a competing risk model that controls for correlation between individual death and survey non-response, I find evidence that individuals with longer lived parents exhibit lower mortality risk. Increases in parental age not only affect mortality through increasing the predisposition to survive, but also through positive information from knowledge of extended parental survival and positive social relationships formed. Also, I find individuals with higher vitality and a higher opportunity cost to completing the survey are less likely to respond in future survey waves.
Keywords: Consumption and Savings; Employment and Labor Force; End of life decisions; Health Conditions and Status; Time Use; Women and Minorities

Diabetes Health and Disability Pathways: Racial/Ethnic, Socioeconomic, and Gender Disparities - Emily J Nicklett (Sociology and Health Services Organization and Policy, 2010)
This dissertation examines how race/ethnicity, socioeconomic status, and gender relate to longitudinal health outcomes among older adults with type 2 diabetes. Further, this dissertation analyzes the extent to which certain factors, such as social ties and health and illness behaviors, mediate this relationship. The outcomes examined are self-reported health status, adherence, and functional limitations. The hypotheses tested are that individuals with less social support--as well as individuals from socially disadvantaged backgrounds--will report lower health status and greater functional limitations relative to individuals from socially privileged backgrounds and relative to individuals greater amounts of social support. Longitudinal survey data is examined from the Health and Retirement Study (HRS) along with the 2003 HRS Diabetes Supplement. Further, qualitative and quantitative data were collected and analyzed from a small sample (30) of community-dwelling seniors. Multi-level modeling and mixed-method analysis is used to examine individual-level patterns of change. Throughout this series of analyses, race/ethnicity, socioeconomic status, and gender were independent predictors of subsequent health and disability outcomes. However, additional characteristics, such as social support and health characteristics, are important mediators of this relationship. As discussed in the second chapter, diabetic support is not significantly associated with health decline, but it is strongly associated with adherence to health-promoting activities consisting of a diabetic regimen. Therefore, the extent to which one receives illness support for a given regimen component is highly positively associated with adhering to that component, although this adherence does not necessarily translate into protection against perceived decline in health. As discussed in the fourth chapter, however, different forms of social support interact strongly with health behaviors to prevent functional decline As diabetes and other chronic illnesses are increasingly recognized as social and public health priorities, it will become more critical to identify proximal and distal mechanisms by which chronic illness trajectories differ. No previous studies have adequately addressed this aim as proposed in this research. The identification of divergent pathways (and in particular, the relationship to mechanisms that can be altered in interventions) over the life course can enable more effective and efficient prevention practices and interventions.
Keywords: Demographics; Event History/Life Cycle; Health Conditions and Status; Healthcare; Other

Do Older Adults Anticipate Relocating?: The Relationship Between Housing Relocation Expectations and Falls - Stoeckel, Kimberly J.; Frank Porell (The Journal of Applied Gerontology, 2010)
The relationship between the occurrence of falls and the expectations older adults have about making future residential moves is examined in this research. Data from the 2002 Health and Retirement Study (HRS) are used to analyze self-reported probabilities of moving among a nationally representative sample of noninstitutionalized adults aged 65 and older. The results show that falls were predictive of anticipation of housing relocation as indicated by more than 50 reported probability of moving within the next 2 years. The results suggest that consideration of housing relocation is greater among older adults who experience tangible events indicative of a trajectory of deteriorating health. Reprinted by permission of Sage Publications Inc., copyright The Southern Gerontological Society.
Keywords: Demographics; Health Conditions and Status; Housing; Methodology; Retirement Planning and Satisfaction

Do wives work hours hurt husbands health? Reassessing the care work deficit thesis - Kristen W Springer (Social Science Research, 2010)
Life expectancy is an important factor that individuals have to take into account for saving and consumption choices. The life-cycle model of consumption and saving behaviour predicts that consumption growth should decrease with higher mortality rates. The aim of this study is to test this hypothesis based on data about subjective longevity expectations from the Health and Retirement Study merged with detailed consumption data from two waves of the Consumption and Activities Mail Survey. This study finds that an increase in subjective mortality by 1 corresponds to an annual decrease in consumption of non-durable goods of around 1.8 .
Keywords: Consumption and Savings; Event History/Life Cycle; Health Conditions and Status

Does Retirement Affect Cognitive Functioning? - Bonsang, Eric; Adam, Stéphane; Perelman, Sergio (Maastricht: METEOR, 2010)
This paper analyzes the effect of retirement on cognitive functioning using two large scale surveys. On the one hand the HRS, a longitudinal survey among individuals aged 50 living in the United States, allows us to control for individual heterogeneity and endogeneity of the retirement decision by using the eligibility age for Social Security as an instrument. On the other hand, a comparable international European survey, SHARE, allows us to identify the causal effect of retirement on cognitive functioning by using the cross-country differences in the age-pattern of retirement. The results highlight in both cases a significant negative, and quantitatively comparable, effect of retirement on cognitive functioning. Our results suggest that promoting labor force participation of older workers is not only desirable to insure the viability of retirement schemes, but it could also delay cognitive decline, and thus the occurrence of associated impairments at older age.
Keywords: Cross-National; Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction

Dynamic Inefficiencies in an Employment-Based Health Insurance System: Theory and Evidence - Fang, Hanming; Alessandro Gavazza (Duke University, 2010)
We investigate the effects of the institutional settings of the U.S. health care system on individuals' life-cycle medical expenditures. We argue that health is a form of human capital that affects labor productivity, and that the employment-based health insurance system may lead to inefficient investment in individuals' health care. The reason is that labor turnover and frictions in the labor market prevent an employer-employee pair from capturing the entire surplus from investment in an employee's health. Thus, the pair underinvests in health capital, and this underinvestment increases medical expenditures during retirement. We provide extensive empirical evidence consistent with the comparative statics predictions of our model using two datasets, the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS). The magnitude of our estimates suggests a significant degree of inefficiency in health investment in the U.S.
Keywords: Consumption and Savings; Event History/Life Cycle; Health Conditions and Status; Healthcare; Other

Education of Children and Differential Mortality of Parents: Do Parents Benefit from Their Children s Attainments? - Esther M Friedman; Robert D. Mare (California Center for Population Research University of California- Los Angeles, 2010)
Contemporary stratification research on developed societies usually views the intergenerational transmission of educational advantage as a one-way effect from parent to child. However, parents investment in their children s education may yield significant returns for parents themselves in later life. Well-educated children have greater knowledge of health and technology to share with their parents and more financial means to provide for parents than do their less-educated counterparts. This paper considers the effects of children s educational attainment on the survival of parents, net of parents own socioeconomic status. We use data from the Health and Retirement Study (HRS) to examine whether children s educational attainment affects parents survival and how these effects compare with those of parents own income and wealth. Our findings suggest that one s own education, income, and wealth are, in fact, associated with mortality. More importantly, though, we find that sons and daughters education have independent effects on parents mortality. We also find that at least part of the association between children s education and parents survival can be explained by the health behaviors of parents.
Keywords: Adult children; Demographics; Health Conditions and Status

The effects of disability on employment patterns among older workers - Hwang, Ju Hee (Michigan State University, 2010)
Given the substantial number of individuals with disabilities and the sheer rapid growth of U.S. aging population, research on labor transition among older people with disability is vital for improving quality of life for society in general, as well as people with disabilities. Nonetheless, there has been a lack of research on labor transition and older individuals with disabilities in the literature. To reduce and further eliminate labor transition among older people with disabilities, as well as to provide effective interventions and policies for eliminating, it is imperative to investigate the existence of labor transition of older workers and elucidate mechanisms in which labor transition occur. The purpose of this study was to investigate the prevalence of late onset disability among older workers, the consequences for their acquired disability on employment patterns, and the determining factors affecting later-life employment transitions. Given a lack of research employing a national data set for employment and older workers with disabilities, this study examined older people aged 50 and over and used the object measures for define a disability. This study was tested chi-square, ANOVA test, binary and multinomial logistic regression. As an ex post facto design, this study employed the Health and Retirement Study data. Of the total 10,890 age-eligible (age over 50) full time workers who reported thoroughly free of disability (healthy) at the time of baseline interview, the final sampling consisted of 1,096 older workers reported functional or mental disability two years later. 506 male (46.2%) and 590 female (53.8%) reported that they are experiencing disabilities. It is about 10.1% prevalence of an acquired disability among full time older workers. Surprisingly, the prevalence of mental disability was 7.3% and the prevalence of functional disability was 2.7% among older labor force participation. Findings for descriptive results show that about 62.4% workers still kept their full time job even though older workers experienced some types of disabilities. Older workers at older ages were much more likely to change their job to a par-time or quit their job than younger workers. Older workers with mental disability consistently have a better chance of being employed and sustaining their full time job than older workers with functional disability. The findings also confirm that older workers with high levels of education, those who are white, those are female and those in white collar occupations seem to more likely continue their full time job Chi-square tests, independent t-test, and ANOVA found that significant differences existed in age, the level of education, type of disability, self employed status, current occupation, industry, and financial factors (earnings, household net assets, and Social Security Retirement Income) between older individuals who kept their job and who quit their full time job. The binary logistic regression and multinomial logistic results support that gender, high level of education, mental disability, self employed status, white collar occupation and white collar related industry, and not depending on social security retirement pension were independently associated with employed older workers. Implications for rehabilitation counselor practice, education and future research are discussed.
Keywords: Disabilities; Employment and Labor Force; Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

Effects of Immigration and Age on Health of Older People in the United States - Chizuko Wakabayashi (Journal of Applied Gerontology, 2010)
Following cumulative advantage/disadvantage theory and drawing longitudinal data from the 1996, 1998, 2000, 2002, 2004, and 2006 Health and Retirement Studies, this article examined the relationship between immigration experience and health transitions in late life among non-Hispanic White, non-Hispanic Black, and Mexicans in the United States. The results revealed that the timing of migration in the life course helped determine the ways in which individual health transitions would be associated with their aging process, and the pathways would be complex and vary based on the health outcomes and gender of the immigrants. For example, among women, the later-life immigrants would face most disadvantageous health trajectories as they aged with respect to activities of daily living limitations. The results suggested that the timing of U.S. immigration would affect the degree to which immigrants could take advantage of economic opportunities to accumulate financial resources that would benefit health later in life.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology

The Effects of Medicaid and Medicare Reforms on the Elderly s Savings and Medical Expenditures - Mariacristina De Nardi; Eric French; John Bailey Jones; Michigan Retirement Research Center (Michigan Retirement Research Center Research Working Paper, 2010)
This study explores the relationship between general human capital investment, financial knowledge, occupational spillovers, and the accumulation of wealth in a primarily descriptive manner. Drawing upon human capital theory and following previous related work by Delavande, Rohwedder and Willis (2008), we hypothesized that individuals with daily exposure to financial knowledge through their occupation would benefit by having greater financial knowledge that would translate into greater wealth accumulation than individuals who do not enjoy such spillovers from their occupation. Using data from the Cognitive Economics Study and the Health and Retirement Study, we find strong evidence that individuals in financial occupations tend to have greater financial knowledge and moderate evidence that they also have greater wealth accumulation.
Keywords: Health Conditions and Status; Net Worth and Assets

Essays on race/ethnic variations in the dynamics of chronic diseases among middle and old aged Americans - A. R. Quinones (University of Michigan, 2010)
This dissertation is composed of three empirical papers on ethnic disparities in chronic disease morbidity. The first paper analyzes intra- and interpersonal differences in comorbidity burden reported by white, black and Mexican Americans. Data come from Health and Retirement Study (HRS) participants aged 51 and over from 1995-2006. Hierarchical linear models are employed to analyze ethnic variations in temporal changes of reported comorbidities. On average, participants have nearly two chronic diseases at the baseline, which increased to almost three conditions over 11 years. Mexican Americans demonstrate lower initial levels and slower accumulation of comorbidities relative to whites. In contrast, blacks show an elevated level of comorbidity, although their rate of change decelerated over time relative to whites. The second paper examines ethnic variations in the onset of hypertension diagnosis for white, black and Mexican Americans age 51 and over. Data came from HRS respondents who report being hypertension-free at the baseline for up to five time intervals (1995-2006). Discrete-time survival models are used to analyze ethnic variations in the probability of developing hypertension. We find the risk of newly diagnosed hypertension increased for all participants. Relative to white and Mexican Americans, black Americans had an elevated risk of incident hypertension throughout the 11-year period of observation. These variations persisted even when differences in health behaviors, socioeconomic status, demographic, and time-varying health characteristics were adjusted. The third paper examines the onset of diabetes mellitus diagnosis for HRS participants 51 and over who report being free of diabetes at the baseline. Discrete-time survival models are used to analyze ethnic variations in the probability of developing diabetes in up to five time intervals (1995-2006). We find the risk of newly diagnosed diabetes increased for all study participants. Relative to white and black Americans, Mexican Americans have a significantly elevated risk of diabetes. Increases in diabetes incidence for Mexican Americans persist through adjustment of health behaviors, socioeconomic status, demographic characteristics and changing health status. In contrast, increases in incident risk for black Americans relative to white Americans operate largely through changes in time-varying health status. Our findings of continued racial and ethnic disparities in chronic disease burden as well as hypertension and diabetes mellitus incidence suggest there are still improvements to be made in prevention efforts aimed at middle and older aged minorities. These empirical papers highlight the importance of social and structural factors as critical policy levers for mitigating chronic disease burden as well as reducing the elevated risk of two pervasive chronic diseases for minorities in the U.S.
Keywords: Demographics; Health Conditions and Status; Healthcare; Public Policy; Women and Minorities

Essays on Selection in Health Survey Data - Maksym Obrizan (Economics, 2010)
In this paper I consider the effects of sample selection in a study of stroke occurrence among Medicare-eligible Americans using the survey on Assets and HEAlth Dynamics among the Oldest Old (AHEAD). First of all, I apply the propensity score method based on the assumption of data missing at random and find no substantial effects of the sample selectivity, similar to Wolinsky et al. (2009). Then I employ a weaker assumption of incidental truncation and extend the Heckman's (1979) sample selection model to the case of a discrete outcome variable (whether a stroke occurred after the baseline). This constitutes the main methodological contribution of the current paper, with potential applications in health, labor and applied economics, where the outcome variable is discrete and selection takes place along multiple dimensions. The sample selection model with binary outcome(s) extends the multivariate probit setup in Chib and Greenberg (1998) to allow some of the responses to be missing. I also use Cholesky factorization of the variance matrix to simplify the Gibbs algorithm in Chib and Greenberg (1998). I do not find strong selection effects driven by the data in my application to the stroke equation. The main substantive contribution of the paper is that there is no evidence of selection in the AHEAD data based on either propensity score or sample selection model. Government shares in total output are characterized by significant variation across countries. In this paper I use a neoclassical growth model to show that in equilibrium government shares decline non-linearly in the price of government services relative to private consumption. I calibrate the model to the US economy and show that it generates government shares which closely match those from the Penn World Table. In addition, I provide empirical evidence showing that relative price of government consumption increases in income and that richer countries tend to have smaller governments if measured at international prices. The systematic relationships between factor productivities, output composition and economic development have not been explored in the literature.
Keywords: Employment and Labor Force; Health Conditions and Status; Healthcare; Income; Methodology; Other

Estimating Dynamic Discrete Choice Models with Hyperbolic Discounting, with an Application to Mammography Decisions - Fang, Hanming; Wang, Yang (NBER Working Paper, 2010)
We extend the semi-parametric estimation method for dynamic discrete choice models using Hotz and Miller's (1993) conditional choice probability (CCP) approach to the setting where individuals may have hyperbolic discounting time preferences and may be naive about their time inconsistency. We illustrate the proposed estimation method with an empirical application of adult women's decisions to undertake mammography to evaluate the importance of present bias and naivety in the under-utilization of this preventive health care. Our results show evidence for both present bias and naivety.
Keywords: Health Conditions and Status; Methodology

Evaluating social factors in diabetes management by Mexican American ethnicity - Huerta, Serina (University of North Texas, 2010)
Differences in Mexican American ethnicity, family and friend social support, and importance of diabetes self-management as related to diabetes management in the older adult population were evaluated with the University of Michigan Health and Retirement Study (HRS) 2003 Diabetes Study. Comparisons were made between Mexican Americans with Type II diabetes and similar non-Hispanic Caucasian and African American individuals with Type II diabetes. Neither family/friend social support nor importance of diabetes self-management were significant predictors of HbA1c levels. Results did not support the idea that perception of receiving support from family/friends or placing importance on diabetes self-management covaried with lower HbAlc level (family/friend: beta = -.13, t = -1.47, p = .143; self management: beta = .08, t = .55, p = .584).
Keywords: Demographics; Health Conditions and Status; Healthcare; Public Policy

Financial Knowledge and Financial Literacy at the Household Level - Alan L Gustman; Thomas L. Steinmeier; N. Tabatabai (NBER Working Paper, 2010)
This paper uses data from the Health and Retirement Study to explore the mechanism that underlies the robust relation found in the literature between cognitive ability, and in particular numeracy, and wealth, income constant. We have a number of findings. First, the more valuable the pension, the more knowledgeable are covered workers about their pensions. We suggest that causality is more likely to run from pension wealth to pension knowledge, rather than the other way around. Second, most measures of cognitive ability, including numeracy, are not significant determinants of pension and Social Security knowledge. Third, standardizing for incomes and other factors, a pension of higher value does not substitute for other forms of wealth. Rather, counting pensions in total wealth, those with more valuable pensions save more for retirement, other things the same. Fourth, there is no evidence that wealth held outside of pensions is influenced by knowledge of pensions. In sum, numeracy does not influence wealth in whole or in part by affecting financial knowledge of one's pension plan, where financial knowledge of the pension then influences other decisions about retirement saving. These findings raise questions about the mechanism that underlies the relation between cognition, especially numeracy, and wealth. From a policy perspective, they suggest that the numeracy-wealth relation should not be taken as evidence that increasing financial literacy will increase the wealth of households as they enter into retirement.
Keywords: Health Conditions and Status; Net Worth and Assets; Other; Pensions

Health and Access Effects of New Drugs: Combining Experimental and Non-Experimental Data - Pierre-Carl Michaud; Darius Lakdawalla; Dana P Goldman; Sood, Neeraj; Cong, Ze (2010)
We propose to combine clinical trial and estimates of behavioral responses in the population to quantify the value of new drug innovations when such values cannot be obtained by randomized experiments alone. New drugs are seen as having two distinct effects on patients. First, they can provide better outcomes for patients currently under treatment, due to better clinical efficacy. Second, they can also provide treatment access to more patients, perhaps by reducing side effects or expanding treatment. We compare these clinical and access effects using claims data, data on the arrival rate of new drugs, and the clinical trials literature on the effectiveness of these drugs. We find that the effect of new drug introductions on the number of patients treated accounts for a substantial majority of the value created by new drugs.
Keywords: Health Conditions and Status; Healthcare; Methodology; Other

Health and Wealth in a Life-Cycle Model - John Karl Scholz; Ananth Seshadri (The University of Michigan, Michigan Retirement Research Center, 2010)
This paper presents a preliminary model of health investments over the life cycle. Health affects both longevity and provides flow utility. We analyze the interplay between consumption choices and investments in health by solving each household s dynamic optimization problem to obtain predictions on health investments and consumption choices over the lifecycle. Our preliminary model does a good job of matching the distribution of medical expenses across households in the sample. We illustrate the scope of future model applications by examining the effects of a stylized Medicare program on patterns of wealth and mortality.
Keywords: Consumption and Savings; Event History/Life Cycle; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Net Worth and Assets

Housing Dissatisfaction and Cognitive Decline in Older Adults - Russell N. James III; Sweaney, Anne L. (Journal of Housing for the Elderly, 2010)
Analysis of a nationally representative, longitudinal survey of community-dwelling Americans over age 50 indicated that rating the physical condition of one s dwelling unit as poor predicted significantly more rapid cognitive decline in subsequent years. This relationship persisted after controlling for a variety of factors such as wealth, income, education, health, family status, neighborhood safety, depression, and initial cognitive ability. Dissatisfaction with the physical conditions of one s housing may have a direct effect on the rate of cognitive decline in older adults. Addressing housing inadequacy for older adults may thus produce a wider range of societal benefits than previously realized.
Keywords: Consumption and Savings; Health Conditions and Status; Housing

The impact of cumulative socioeconomic inequalities on physical functioning, self-rated health, and depression among older adults - Kim, Jinhyun (Social Work, 2010)
Socioeconomic inequalities have been viewed as significant contributors to health disparities. However, little is known about the impact of cumulative socioeconomic inequalities on physical functioning, self-rated health, and depression across time, especially in later life. In addition, despite a strong connection between socioeconomic inequalities and the presence of private health insurance, few studies have examined how lack of private health insurance affects individuals' health trajectories. Thus, this study focuses on the impact of socioeconomic inequalities and lack of private health insurance on physical functioning, self-rated health, and depression using longitudinal panel data from the Health and Retirement Study (HRS). The latent growth curve model was conducted in three steps: unconditional model, conditional model, and multiple group analysis. First, the unconditional growth curve model presented that individuals' physical functioning, self-rated health, and depression tend to worsen as people age. However, significant variability in the initial level of health outcomes and their rate of change among individuals were found. Second, the conditional growth curve model was conducted to test potential covariate effects on this variability. Results from the conditional model showed that higher level of income and assets significantly predicted better physical functioning and self-rated health but less depressive symptoms. In particular, increases in income or assets significantly predicted slower worsening in physical functioning, self-rated health, and depression. However, iii higher level of education was a significant predictor for better self-rated health and less depression at baseline but not for physical functioning. In addition, having private health insurance significantly predicted better physical functioning, self-rated health, and less depressive symptoms at baseline. In particular, decline in physical functioning was slower among those who have private health insurance over time. Third, the multiple group analysis was conducted to examine potential moderating effects of gender and race on health trajectories. Results from the multiple group analysis showed that economic status had greater impact on females' declines in physical functioning, self-rated health, and depression than on males'. Despite lower initial level of physical functioning and self-rated health among Blacks than among Whites, they were less likely to suffer rapid declines in physical functioning and self-rated health after controlling for socioeconomic status. These results indicated that Blacks might have resilience factors such as religious activities and social support networks buffer health declines. Specific implications for social policy, practice, and research are discussed.
Keywords: Demographics; Health Conditions and Status; Healthcare; Other; Women and Minorities

The impact of health insurance on cancer prevention: Ex ante and ex post moral hazards - Tang, Li (Economics, 2010)
The classic model of moral hazard suggests that health insurance may reduce preventive care because the insurer will pay for part of the treatment in case of disease. However, if health insurance covers preventive care as well, the reduced cost of preventive care will encourage the insured to consume more preventive care. These two countervailing effects are referred to as ex ante and ex post moral hazards (Zweifel & Manning 2000). Most studies do not distinguish the two effects, leading to a potentially wrong characterization of moral hazard. Using Medicare coverage as an example, this thesis identifies ex ante and ex post moral hazard effects of health insurance on cancer prevention. As we know, Medicare eligibility rules increase health insurance coverage at age 65. However, some preventive screenings were not covered in Medicare until recently. The different timing of Medicare eligibility and Medicare expansion of preventive care allows me to use a difference-in-differences framework to separate ex ante and ex post moral hazards. I focus on female uptake of breast cancer screening and male uptake of prostate cancer screening, using the Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS). In both datasets, I find evidence in support of ex ante and ex post moral hazards. No evidence shows that people try to delay screening until it has been covered by Medicare. Moreover, the level of prevention and responsiveness to insurance changes vary with demographics, with larger effects among whites and the better-educated. Then I take a second look at the moral hazard problem in the health insurance market using the Health and Retirement Study (HRS). Compared with MEPS or NHIS, the panel nature of HRS allows me to control for individual fixed effects and therefore provides a more stringent test. The major findings on female uptake of breast cancer screening are consistent. I find strong ex ante and ex post moral hazard effects in female uptake of breast cancer screening, and individual reactions to Medicare enrollment and Medicare's preventive care coverage vary by factors such as race and income. However, moral hazards on male uptake of prostate cancer screening is not found, mainly due to poor quality of data.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Other

The Influence of Individual Characteristics and Cohort Membership on Preventive Service Use in the Near Elderly - Petigara, Tanaz Kavas (The Johns Hopkins University, 2010)
Despite the known benefits of preventive care in reducing morbidity and mortality, many Americans do not receive preventive services. Among the near elderly (50-64 years), the use of preventive services remains below recommended levels. Using the Health and Retirement Study, this dissertation examined the influence of individual characteristics and cohort membership on preventive service use in the near elderly through three separate analyses. The first examined differences in preventive service use between two near elderly birth cohorts. The second examined characteristics associated with different influenza vaccination patterns--no vaccination versus receiving at least one vaccination; and intermittent compared to regular vaccination. The third compared characteristics associated with receiving intermittent or regular mammograms in near elderly women. Results show that improvements in education, income, and access to medical care in the later birth cohort led to increases in their use of preventive services. Other factors such as increases in obesity could adversely affect the preventive service use in future near elderly cohorts. In addition, the characteristics associated with the use of preventive care differ by type of service. There were some differences in the factors associated with the two vaccination patterns. Predisposing characteristics--age, gender, race, marital status, and education were significant predictors of receiving at least one vaccination. However, only race and education were associated with regular vaccination. Insurance, chronic conditions, and physician visits were associated with both vaccination patterns. In comparison, enabling but not predisposing characteristics--insurance, income, and physician visits, were significant predictors of regular mammography. Obese women and those in poor health were also less likely to receive regular mammograms. The health of the near elderly and their use of medical care are increasingly important to policymakers because of their impact on Medicare. Several proposals have been developed to allow the uninsured near elderly to buy-in to Medicare. However, this dissertation shows that in addition to health insurance, other characteristics such as cohort membership also influence preventive service use among near elderly individuals. It may also be useful for policymakers to consider that the characteristics associated with preventive service use differ by type of service.
Keywords: Health Conditions and Status; Healthcare; Other

Investigating age group differences in depression symptoms among older adults with operational impairments - Kohnke, Kevin J. (The University of Nebraska - Lincoln, 2010)
Health and Retirement Study data from 2006 was used to examine whether health has a moderating effect on the relationship between age and depression. The sample consisted of 9,988 respondents in the 2006 data sample. Ages ranged from 41 to 102 with an average age of 69 and a standard deviation (SD) of 11.0 years. Gender, race/ethnicity, marital status, number of years of education, work status, and perceived health status were each analyzed by Ordinary Least Squares to determine the true population relationship between each of these factors and the depression of the participants. The majority (54%) of the sample was female; 50% were married, and 25% were widowed. Only 26% were working full-time. The large majority were Caucasian, with 16.5% being African-American. The mean level of education in years was 12.4 with an SD of 3.3 years. Health, measured by ADL and IADL was allowed to freely vary, rather than restricting its variance by selecting only those with ADL or IADL limitations. The average level of depressive symptomatology, ranging from 0 to 8, was quite low with a mean of 1.6 depressive symptoms and an SD of 2.0. This indicates the average person experienced less than 2 symptoms. DSM-IV, for example, requires 5 or more for a diagnosis of depression. Self-rated health had the largest unique effect on health ( B = - .25), indicating that as health declined, the number of depressive symptomatologies increased. ADL limitations exerted the next largest unique effect ( B = .18), indicating an increase in depressive symptoms with increasing ADL limitations. IADL limitations operated in a similar manner. As hypothesized, age was significantly related to the level of depressive symptoms with the number of symptoms growing with increasing age. With the present data it seems that age does have a significant, independent effect on depression for those suffering from at least one limitation of ADL or IADL. Only one interaction, age by IADL, had a significant unique effect on depressive symptomatology (t(1) =3.4; p<.01). The contribution of the set was trivial, explaining only .004% additional variance in depressive symptomatology.
Keywords: Health Conditions and Status; Healthcare

Joint retirement process of dual-worker couples: Expectations, experience, and depressive symptoms - Ho, Jeong-Hwa (The University of Wisconsin - Madison, 2010)
With the continuous increase in women's labor force participation, women now comprise about half of the labor force and the majority of couples are dual-worker couples. As a consequence, a growing number of couples have two retirements to coordinate at the end of their careers. Joint retirement happens when both spouses retire within a relatively short period of time and about twenty to forty percent of dual-worker couples retire jointly. It reflects the changing context of retirement and labor force participation in later life and has implications for individual well-being, academic research, and social policy regarding retirement. In this dissertation, I explore the joint retirement process by focusing on three phases: preretirement expectations, subsequent experience, and postretirement depressive symptoms. I examine how these phases are interconnected and to what degree characteristics of husbands and wives influence joint retirement. I use seven waves of panel data from the Health and Retirement Study (1992-2004). I find that about one in four dual-worker couples expect to retire jointly. Couples with higher preferences for shared leisure and couples receiving fewer intrinsic rewards from work are more likely to expect joint retirement. I find consistency between joint retirement expectations and subsequent experience. Couples in which both spouses expected joint retirement are over four times more likely to retire jointly compared to couples in which neither spouse expected to do so. When spouses had discordant expectations, joint retirement experience reflects husbands' and wives' expectations equally. Among couples in which both spouses expected to retire jointly, those who discussed retirement often are more likely to realize their expectations. I also find that joint retirement per se is not significantly related to postretirement depressive symptoms. Rather, the associations are contingent on previous expectations. Unlike findings of previous studies on consistency between expectations and subsequent experience, individuals who expected joint retirement are more likely to have restless sleep when they realized their expectations and retire jointly, compared to when they did not retire jointly. I speculate that poor health status and unrealistic expectations regarding retirement life may be reasons for this negative link. I conclude with discussion of the implications of this dissertation for research on retirement, social policy, and retirement education.
Keywords: Demographics; Employment and Labor Force; Expectations; Health Conditions and Status; Other; Retirement Planning and Satisfaction

Mortality Differences in Windowhood - Allison R Sullivan (Philadelphia, PA, Population Studies Center, University of Pennsylvania, 2010)
Being widowed elevates mortality risk, relative to married men or women of the same age. I investigate how risk varies by subpopulation of widows and widowers. Specifically, using data from the Health and Retirement Study, I test for differences in widowhood mortality by education, by number of children, and by how sudden or expected the death of the pre-decedent spouse was. Consistent with other studies, I find an increased hazard of mortality upon widowhood. In contrast with other studies but consistent with the larger literature on SES and mortality, education is protective in widowhood. Number of children has a u-shaped association with mortality in widowhood, with those having 3-4 children having the lowest levels of mortality after death of a spouse. Lingering deaths (deaths after a chronic condition) of the predecedent spouse are much for the surviving spouse than sudden deaths or other types of death. Important gender differences occur with each of these effects. These findings illuminate mechanisms through which mortality is affected by widowhood, and provide evidence on the power of SES and social support in vulnerable populations.
Keywords: Adult children; Health Conditions and Status; Net Worth and Assets

Obesity and survival awareness - Beatriz Novak (The University of Wisconsin - Madison, 2010)
During the last two decades or so, obesity prevalence has increased worldwide and research on the topic has mushroomed. The effects of obesity on mortality, morbidity, disability, mental health, and quality of life, as well as its economic repercussions have been the subject of extensive study. However, perceptions of individuals about the effect of their own excessive body weight on their health and ultimately on their future survival have scarcely been investigated. This dissertation studies variability in individual perceptions and its determinants. First, I focus on the relationship between individuals' characteristics and their subjective probabilities of surviving to a target age across subgroups defined by body weight levels. The analysis uses data from the first eight waves of the Health and Retirement Study (HRS). Results suggest that on average obese individuals expect to have a shorter lifespan than normal weight ones do. This result may respond to a combination of causes, on the one hand the relationship between higher levels of BMI and subjective survival is mediated by health status. On the other hand, obesity-related diseases, which are more prevalent among obese individuals than they are among normal weight ones, have a greater impact on future survival expectations precisely among obese individuals than they have among normal weight ones. Second, I study the process that leads to updating survival expectations upon acquiring adverse health information. I use HRS data to analyze the updating process in two different periods, 1994-1996 and 2004-2006, and employ a Bayesian updating framework. Findings show that health shocks that are not obesity-related negatively influence subjective survival estimates among individuals in all body weight subgroups in the 2006 sample (only among normal weight ones in the 1996 sample). Individuals in the obese subgroup seem to assign similar importance to both obesity-related and not obesity-related health shocks. Third, I study awareness of effects of excess body weight and determinants of survival expectations in the context of one developing county, Costa Rica. I use CRELES (Costa Rican Study on Longevity and Health Aging) and show that processes are very similar to those identified in the US.
Keywords: Expectations; Health Conditions and Status

Occupational Learning, Financial Knowledge, and the Accumulation of Retirement Wealth - Brooke Helppie; Kandice Kapinos; Robert J. Willis; Michigan Retirement Research Center (Working Paper, 2010)
This study explores the relationship between general human capital investment, financial knowledge, occupational spillovers, and the accumulation of wealth in a primarily descriptive manner. Drawing upon human capital theory and following previous related work by Delavande, Rohwedder and Willis (2008), we hypothesized that individuals with daily exposure to financial knowledge through their occupation would benefit by having greater financial knowledge that would translate into greater wealth accumulation than individuals who do not enjoy such spillovers from their occupation. Using data from the Cognitive Economics Study and the Health and Retirement Study, we find strong evidence that individuals in financial occupations tend to have greater financial knowledge and moderate evidence that they also have greater wealth accumulation.
Keywords: Health Conditions and Status; Net Worth and Assets

Older adults with visual impairments: The role of health dimensions in predicting falls - Bernard A Steinman (Gerontology, 2010)
The purpose of this dissertation was to examine relationships between self reported vision impairment, health dimensions, and falls among older people; and to describe an indirect pathway through which vision loss may increase risk for falls by way of poor health outcomes in dimensions of health that are believed to lead to disability. Whereas previous research has tended to focus on direct effects of vision loss on fall risk, the primary goal of this research was to examine integrated effects between systems that might lead to increased fall risk via moderated or mediated relationships. First, in order to establish health disparities by self reported vision status, binary and multinomial logistic regression models were performed using data from the National Health and Nutrition Examination Survey, 1999-2008 (N=6,693) to estimate the probability of negative health outcomes across four dimensions of health, including biological risk, pathological conditions, functional difficulties and disability in daily living activities, by vision status. Results suggest that older adults with poor vision have greater likelihood of experiencing negative health outcomes across the four dimensions. Next, two waves (2004 & 2006) from the Health and Retirement Study (HRS) (N=8,449) were analyzed using binary logistic regression to investigate whether a moderating relationship exists between vision status and upper and lower limb functioning. This relationship was hypothesized to derive, in part, from decreased physical activity that often follows vision loss in late life, to result in poorer functional ability. Little evidence was found for a moderating effect of self-reported vision status on musculoskeletal health and functioning; however, results suggest that declines and/or gains in functioning across short periods of time may supercede self-reported vision as a predictor of falls. Thus, poor self-reported vision status may not be as good an indicator of fall risk in older adults as might otherwise be assumed. In a third study, two waves (2006 & 2008) from HRS (N = 9,143) were used to test whether functional difficulties and disability with daily living activities mediate self-reported vision loss to increase fall risk among older adults. Binary logistic and Poisson regression analyses were conducted to test indirect paths leading from self-reported vision to falls, through declines in indices of functioning and disability. No evidence was found for a mediating effect among women; however, for men, large muscle groups were implicated as partially mediating risk factors for falls among participants with poor vision. Finally, implications of the three studies are discussed, including the need for prioritizing improved muscle strength of older persons with vision impairments as preventive measure against falls. It is acknowledged that the most effective fall prevention interventions are likely multifactorial in structure; therefore, interventions pertaining to education, medical assessment, exercise, and home assessment and modification are discussed with respect to older persons who have vision impairments.
Keywords: Health Conditions and Status; Healthcare

Personality, Lifetime Earnings, and Retirement Wealth - Angela Lee Duckworth; David R Weir; Michigan Retirement Research Center (Michigan Retirement Research Center, University of Michigan, 2010)
Studies of adolescents and young adults have shown that schooling impacts economic outcomes beyond its impact on cognitive ability. Research has also shown that the personality trait of conscientiousness predicts health outcomes, academic outcomes, and divorce. Using the Big Five taxonomy of personality traits, this study examines whether non-cognitive traits are related to economic success over the life course. Examining Health and Retirement Study survey data linked to Social Security records on over 10,000 adults age 50 and over, we investigate the relationship of personality traits to economic outcomes. Controlling for cognitive ability and background variables, do more conscientious and emotionally stable adults have higher lifetime earnings, and is this due to higher annual earnings, longer work lives, or both? Do more conscientious adults save a higher proportion of their earnings for retirement, and does conscientiousness of each partner in a married couple matter? Do conscientiousness and emotional stability interact such that the effects of conscientiousness are greater among less emotionally stable adults?
Keywords: Health Conditions and Status; Healthcare; Public Policy; Social Security

Prediction of disease status: A regressive model approach for repeated measures - M. Ataharul Islam; Rafiqul I Chowdhury (Statistical Methodology, 2010)
In this paper, regressive models are proposed for modeling a sequence of transitions in longitudinal data. These models are employed to predict the future status of the outcome variable of the individuals on the basis of their underlying background characteristics or risk factors. The estimation of parameters and also estimates of conditional and unconditional probabilities are shown for repeated measures. The goodness of fit tests are extended in this paper on the basis of the deviance and the Hosmer-Lemeshow procedures and generalized to repeated measures. In addition, to measure the suitability of the proposed models for predicting the disease status, we have extended the ROC curve approach to repeated measures. The procedure is shown for the conditional models for any order as well as for the unconditional model, to predict the outcome at the end of the study. The test procedures are also suggested. For testing the differences between areas under the ROC curves in subsequent follow-ups, two different test procedures are employed, one of which is based on permutation test. In this paper, an unconditional model is proposed on the basis of conditional models for the disease progression of depression among the elderly population in the USA on the basis of the Health and Retirement Survey data collected longitudinally. The illustration shows that the disease progression observed conditionally can be employed to predict the outcome and the role of selected variables and the previous outcomes can be utilized for predictive purposes. The results show that the percentage of correct predictions of a disease is quite high and the measures of sensitivity and specificity are also reasonably impressive. The extended measures of area under the ROC curve show that the models provide a reasonably good fit in terms of predicting the disease status during a long period of time. This procedure will have extensive applications in the field of longitudinal data analysis where the objective is to obtain estimates of unconditional probabilities on the basis of series of conditional transitional models.
Keywords: Health Conditions and Status; Methodology; Other; Risk Taking

Psychiatric history and cognition trajectories in later life: Variation by sex, race and ethnicity, and childhood disadvantage - Maria T. Brown (Syracuse University, 2010)
Advocates of the life course perspective suggest that cumulative inequality affects later-life cognitive function, and that a history of psychiatric problems may be detrimental to cognition among individuals at risk of experiencing cumulative disadvantage. Psychiatric conditions are more prevalent among disadvantaged groups, who may also be at risk of experiencing cognitive decline in later life. Therefore, it is important to explore the relationships between sex, race/ethnicity, childhood disadvantage, psychiatric history, and cognitive function. This study addresses the following research questions: (1) Do individuals with a history of psychiatric problems have lower initial cognitive functioning and/or a unique trajectory of cognitive function with age? (2) Does the relationship between psychiatric history and cognitive function in later life change when controlling for ascribed, early-life, and later-life characteristics? (3) Do ascribed characteristics interact with psychiatric history to affect cognitive function in later life? This study applies growth curve models to analyze six waves of Health and Retirement Study data, examining influences on total cognitive function and three components of cognitive function, while controlling for demographic and health variables. The psychiatric history variable includes psychiatric, emotional, and nervous problems. Findings indicate that psychiatric history is related to lower cognition and steeper rates of decline, and that race/ethnicity and childhood disadvantage are also related to cognition. These findings also demonstrate that cumulative disadvantage and psychiatric history shape later-life cognition and decline and can enhance our understanding of trajectories of cognitive decline experienced by disadvantaged groups.
Keywords: Adult children; Demographics; Health Conditions and Status

A Quantile Estimation Approach to Identify Income and Age Variation in the Value of a Statistical Life - Mary F. Evans; Schaur, Georg (Journal of Environmental Economics and Management, 2010)
In theory, heterogeneity in individual characteristics translates into variation in the marginal willingness to pay for a mortality risk reduction. Two dimensions of heterogeneity, with respect to income and age, have recently received attention due to their policy relevance. We propose a quantile regression approach to simultaneously explore these two sources of heterogeneity and their interactions within the context of the hedonic wage model, the most common revealed preference approach for obtaining value of statistical life estimates. We illustrate the approach using data from the Health and Retirement Study (HRS). We find that the impact of age on the wage-risk tradeoff varies across the wage distribution. This result indicates important interactions between age and income heterogeneity. Thus, the conventional mean hedonic wage regression, even when the mean effect is allowed to vary with age, masks important heterogeneity.
Keywords: Health Conditions and Status; Income; Methodology

The Risk of Out-of-Pocket Health Care Expenditure at End of Life - Samuel M Marshall; Kathleen McGarry; Jonathan S Skinner (NBER Working Paper, 2010)
There is conflicting evidence on the importance of out-of-pocket medical expenditures as a risk to financial security, particularly at older ages. We revisit this question, focusing on health care spending near the end of life using data from the Health and Retirement Study for the years 1998-2006. We address difficulties with missing values for various categories of expenditures, outliers, and variations across individuals in the length of the reporting period. Spending in the last year of life is estimated to be 11,618 on average, with the 90th percentile equal to 29,335, the 95th percentile 49,907, and the 99th equal to 94,310. These spending measures represent a substantial fraction of liquid wealth for decedents. Total out-of-pocket expenditures are strongly positively related to wealth and weakly related to income. We find evidence for a mechanism by which wealth could plausibly buy health: large expenditures on home modifications, helpers, home health care, and higher-quality nursing homes, which have been shown elsewhere to improve longevity.
Keywords: Demographics; Health Conditions and Status; Healthcare; Net Worth and Assets

The Role of Dependency in Adult Child and Older Parent Migration Decisions: Impacts of Air Pollution Exposeures - Mary F. Evans; V. Kerry Smith (Ann Arbor, University of Michigan, 2010)
Keywords: Adult children; Health Conditions and Status

Self-reported neighborhood environment and risk of type 2 diabetes in the Health and Retirement Study and English Longitudinal Study of Ageing - Goldoftas, Barbara (Boston University, 2010)
Keywords: Demographics; Health Conditions and Status; Retirement Planning and Satisfaction

Social security claiming of the elderly in the United States - Peng, Yu-I (University of Washington, 2010)
This dissertation comprehensively studies the behavior of Social Security retirement benefit claiming of the elderly in the United States, using data from the 1992-2006 Health and Retirement Study (HRS) and the supplement "Prospective Social Security Wealth Measures of Pre-retirees". This dissertation begins by modeling the claiming behavior of Social Security retirement beneficiaries under a framework incorporating the incentives for married couples. For individuals who retire by age 62 (the earliest entitlement age), the results indicate that the expected amount of benefit is a strong predictor for the timing of claiming. However, life expectancy, consistent with previous studies, is not a critical determinant of the claiming decision alone, even after taking into account the dependent spouse's longevity expectation. The second chapter models the claiming behavior among individuals who have not retired by age 62 jointly with their retirement behavior. The results show a high correlation between the two decisions. By breaking down the sample, it is found that claiming is attached to retirement; after withdrawal from the labor force and with no labor income, retirees would rely on the Social Security benefits, and liquidity holding becomes a major factor explaining how soon retirees claim their benefits. However, for late-retiring workers, the Social Security retirement benefits do not give much retirement incentive. The third chapter of this dissertation brings in one of the most important Social Security mechanisms, the Social Security earnings test, and takes advantage of its recent reform, the abolishment of the test above the Normal Retirement Age (NRA) in year 2000, to analyze the role of the earnings test in the decisions of claiming and retirement. The earnings test is found to be a crucial factor that links the dates of them.
Keywords: Employment and Labor Force; Health Conditions and Status; Pensions; Public Policy; Retirement Planning and Satisfaction; Social Security

Social Ties and Depression: An Intersectional Examination of Black and White Community-Dwelling Older Adults - Christine A Mair (Journal of Applied Gerontology, 2010)
Aging literature often links social ties to lower depression for older adults; however, research shows inconsistent findings by race and gender. Drawing from an intersectionality framework, this article explores whether the relationship between social ties and depression is moderated by race and gender for a nationally representative sample of diverse, community-dwelling older adults (aged 60 and older). Analysis of the most recent wave of the Health and Retirement Study (HRS) indicates that White men, Black men, White women, and Black women differ in terms of the relationship between social ties and depression. Main findings include (a) the overwhelming benefit of marriage and partnership, (b) pronounced differences between Black women s and White women s friend and kin ties, and (c) the potential vulnerability of older Black men. Findings highlight the importance of catering community-based elder support toward diverse aging populations. Potential community-based care solutions are discussed.
Keywords: Demographics; Health Conditions and Status; Other

Socio-economic Status and Mortality: Perceptions and Outcomes - David R Weir (2010)
This paper draws on over 300,000 person-years of mortality observation on over 30,000 participants in the Health and Retirement Study (HRS) to study the relationship of education, income, and wealth to mortality expectations and mortality outcomes in older Americans. Using quintiles to facilitate comparison across variables, we find that all three SES measures significantly predict mortality, but that in joint models education is dominated by the other two which are realized later in life, and particularly by wealth. As others have found, SES differentials in mortality decline with age, though wealth remains a powerful determinant even at advanced ages. When strictly interpreted as expressions of relative risk, the subjective probabilities of survival offered by HRS respondents substantially understate the true differentials by SES, as they do for other factors like smoking and very low or very high body weight. In particular, the large mortality disadvantage of low wealth is not recognized. SES accounts for most of black-white differentials in mortality, whereas it unveils an Hispanic advantage relative to other whites that was masked by lower SES.
Keywords: Demographics; Health Conditions and Status

Spending Patterns in the Older Population - Michael D Hurd; Susann Rohwedder (Aging Consumer: Perspectives from Psychology and Economics, 2010)
This chapter deals with the concrete differences in consumption behavior across a person's life span. Although there is a prevasive belief that households reduce consumption at retirement, the interpretation that consumers adjust their spending after discovering they have fewer economic resources than they had anticipated prior to retirement is not wholly consistent with empirial evidence. The spending habits of older adults are determined by a variety of factors like age, marital status, and economic resources. Specifically, as the population ages, it will tend to spend less on transportation services, vacations, and food; and more on health care and charitable giving.
Keywords: Consumption and Savings; Demographics; Health Conditions and Status; Retirement Planning and Satisfaction

Subjective Mortality Expectations and Consumption and Saving Behaviours among the Elderly - Salm, Martin (Canadian Journal of Economics, 2010)
Life expectancy is an important factor that individuals have to take into account for saving and consumption choices. The life-cycle model of consumption and saving behaviour predicts that consumption growth should decrease with higher mortality rates. The aim of this study is to test this hypothesis based on data about subjective longevity expectations from the Health and Retirement Study merged with detailed consumption data from two waves of the Consumption and Activities Mail Survey. This study finds that an increase in subjective mortality by 1 corresponds to an annual decrease in consumption of non-durable goods of around 1.8 .
Keywords: Consumption and Savings; Employment and Labor Force; Event History/Life Cycle; Health Conditions and Status; Women and Minorities

Three Essays on Cancer Survivorship and Labor Supply - Markowski, Michael P. (College of Health and Human Development, 2010)
These essays examine the effects of cancer on labor supply by cancer survivors in three situations: patients deciding whether to continue working during treatment, spouses deciding whether and how much to work in the years following treatment, and survivors deciding about the timing of retirement. These choices affect individual and societal welfare. Work matters to individual cancer survivors because it is a source of personal fulfillment, a measure of health and vitality, income, and employer-sponsored health insurance benefits. Work matters to society. The National Cancer Institute has estimated that cancer costs over $20 billion annually in work-loss days. Efforts to support and accommodate work by cancer survivors would reduce the indirect economic costs of cancer to society and would potentially improve the well-being of cancer survivors and their families. Although sixty percent of newly diagnosed cancer survivors decide to continue to work during treatment, little is known about the factors that are associated with that decision. Furthermore, spouses share in the cancer survivorship journey, yet the labor supply effect of cancer on spouses in working couples is unknown. With the incidence of cancer increasing with age, the labor supply decision of older cancer survivors increasingly becomes a decision about retirement. The studies use data from the Penn State Cancer Survivor Study (PSCSS) funded by the National Cancer Institute, and supplemented with data from the Health and Retirement Study (HRS), to produce estimates of the effects of cancer on work status and the usual hours of work per week for cancer survivors and spouses at difference stages of survivorship. Logistic regression methods were used to produce estimates of the effects of cancer on working or on complete retirement. Tobit models were used to estimate the effect of cancer on hours of work. The first study finds that the decision to work during treatment is mainly determined by clinical considerations, such as cancer type and stage, although job-related health insurance of survivors and spouses is associated with a greater likelihood of working through treatment. The second study finds that cancer has little long-term effect on the labor supply of the spouses of survivors, at least in older couples or where both partners were working at diagnosis, the situations that were the focus of this research. The third study finds that survivors of both genders who remain cancer-free postpone retirement compared to other adults with no cancer history, but female survivors with recurrences or new cancers retire sooner.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Retirement Planning and Satisfaction

Three essays on the economics of household decision making - Bhatt, Vipul (Economics, 2010)
My research emphasizes the role of interrelated preferences in determining economic choices within a household. In this regard, I study both intergenerational interactions (between parents and children) and intragenerational interactions (between spouses). These linkages have important implications on individual economic behavior such as savings, labor supply, investment in human capital, and bequests which in turn affects aggregate savings and growth. Standard altruism models developed by Barro and Becker are based on an important assumption that parents and children have homogeneous discount factors, which precludes any role parents can play in influencing their child's time preferences. However, there is empirical evidence that parents attempt to shape their children's attitudes. The first essay of my dissertation, "Tough Love and Intergenerational Altruism" (based on this I also have a joint work with Masao Ogaki), proposes a framework to study the role of parents in shaping children's time preferences. The tough love altruism model modifies the standard altruism model in two ways. First, the child's discount factor is endogenously determined so that low consumption at young ages leads to a higher discount factor later in her life. Second, the parent evaluates the child's lifetime utility with a constant high discount factor. In contrast to the predictions of the standard model that transfers are independent of exogenous changes in the child's discount factor, the tough love altruism model predicts that transfers from the parent will fall when the child's discount factor falls. Thus, our model is more consistent with empirical evidence on parental punishments than the standard altruism model. The second essay, "Adolescent Substance Use and Intergenerational Transfers: Evidence from Micro Data," provides empirical evidence for the use of pecuniary incentives by the parent to influence child behavior. Using the first seven waves of the National Longitudinal Survey of Youth, 1997 (NLSY97), I measure the effect of child alcohol consumption on parental transfers. Owing to the plausible endogeneity of the child's alcohol use in the regression equation of transfers she receives from parents, I estimate this relationship using an instrumental variable which utilizes variation in the price of alcoholic beverages over time and across states as a source of exogenous variation. The main finding of the paper is that after accounting for the possible endogeneity of substance use, the incidence of alcohol consumption among youths significantly reduces the amount of parental transfers they receive. Given the robust evidence for a negative correlation between youth substance use and their discount factor in the economics and psychology literature, this result provides an empirical basis for the tough love model of intergenerational altruism. The existing literature on joint retirement suggests that married couples tend to coordinate their retirement decisions which seem to be largely explained by the complementarity in their preferences for leisure. However, the recent trend toward increased labor force participation of older married women may make synchronization of retirement decisions more difficult as more recent cohorts of women become more strongly attached to the labor force and build their own careers, a fact that has been overlooked in the literature. My third essay, "Cross-Cohort Differences in Joint Retirement: Evidence from the Health and Retirement Study," uses the Health and Retirement Study (HRS) data from 1992 through 2006 to document that the likelihood of a married couple jointly exiting the labor force (given that both were employed in the previous period) decreases across successive birth cohorts of wives. I then estimate a discrete choice multinomial model of labor force transition for married couples and find that, while economic factors have substantial power in explaining variation across married couples in retirement behavior, trends across cohorts in these factors do not contribute significantly towards explaining the observed cohort trend in joint retirement. This result suggests that non-economic factors, such as changes in social norms and attitudes towards work, are likely to be more important explanations for this observed trend. From a policy perspective, an implication of this finding is that the bias in the estimated effect of a policy aimed at influencing older workers' labor force behavior (caused by ignoring potential interactions in retirement decisions of spouses) can be mitigated if recent cohorts are less likely to retire together.
Keywords: Adult children; Health Conditions and Status; Retirement Planning and Satisfaction

Trigger Events and Financial Outcomes Among Older Households - Geoffrey L Wallace; Haveman, Robert; Karen C. Holden; Barbara Wolfe (Center for Financial Security Working Paper, 2010)
Follow a sample of social security beneficiaries drawn from the Health and Retirement Study from their first year of retirement up to 15 years into retirement, we estimate rates at which retirees are subject to family structure change, cognitive decline, health decline, and other events. Then we assess the vulnerability of wealth and wealth-based adequacy measures to adverse events, drawing conclusions about the effect of events on a wealth-based measure and a wealth-based inadequacy measure. Our findings highlight the importance of cognitive and health decline as events with the potential to shape the evolution of wealth post-retirement.
Keywords: Adult children; Health Conditions and Status; Healthcare; Net Worth and Assets; Social Security

Understanding Quality of Life in Older Adults - Cardona, Laura A (Psychology, 2010)
I analyzed the 2004 and 2006 Health and Retirement Study data to test structural equation models of the quality of life (QOL) construct. The participants ( N =1352) were non-institutionalized individuals aged 42 and older ( M =65.70, SD =10.88), with an average education of 12.73 years ( SD =2.96) and of varied ethnicities. The results indicated that physical functioning, affective experience, life satisfaction and social support could serve as indicators for a second order QOL factor. Furthermore, the developed QOL model explained 96% of the variance of the CASP-19 (Control, Autonomy, Self-realization and Pleasure), a QOL measure that reflects fulfillment of psychological needs. The results also indicated that Depression and Life Satisfaction are related through reciprocal causation and that Physical Functioning is more likely to cause a change in Depression than the reverse. The results suggest that QOL is a complex, multidimensional concept that should be studied at different levels of analysis.
Keywords: Health Conditions and Status; Healthcare

Using Developmental Trajectories of Cognitive Performance and Cardiovascular Risk Factors for the Early Prediction of Alzheimer's Disease and Vascular Dementia in Late Adulthood - Koontz, Jennifer M. (Psychology, 2010)
The purpose of this thesis is to examine risk factors present before the diagnosis of dementia in the Aging, Demographics and Memory Study (ADAMS), a sample of 856 participants chosen from the Health and Retirement Study (HRS), a nationally representative sample of persons of retiring age and older, to take part in a clinical assessment for cognitive impairment and collection of other health information. A subset of 330 individuals from the ADAMS study diagnosed with either Alzheimer's disease (AD) or vascular dementia (VaD) was considered in the primary analyses. Risk factors examined were age, gender, years of education, APO-[varepsilon] status, and empirical Bayes estimates of latent growth curve trajectory components of longitudinal episodic memory performance, mental status and cardiovascular risk to test whether it was possible to discriminate whether a participant would be later diagnosed with either Alzheimer's disease (AD) or vascular dementia (VaD). Data from the HRS from up to a decade before diagnosis were used in logistic regression analyses to find the best fitting model of prediction into groups of either AD or VaD. Results showed that while age, gender, number of APO-[varepsilon]4alleles, episodic memory and cardiovascular risk factors were predictive of later diagnosis of AD versus VaD subtypes, educational attainment and longitudinal mental status trajectories were not significant predictors. Each APO-[varepsilon]4 allele more than doubled the odds of being classified into the AD group (OR =2.48). Higher levels of performance and maintenance of episodic memory ability across age decreased the odds of being classified in the AD group (OR Intercept = 0.92; OR Slope = 0.79). Every unit of increased cardiovascular risk tended to decrease the odds of being classified into the AD group (OR = 0.77). An attempt was made to examine mixed dementia cases by a re-categorization of participants with vascular pathology into new groups of mixed cases versus a more 'pure' AD group but the percent of cases that were correctly classified decreased from 79.7% in the original analyses to 77.9% once re-organized, indicating more may need to be done to get at underlying risk and cognitive factors involved in mixed dementia.
Keywords: Health Conditions and Status; Healthcare

Using generalized estimating equations to analyze alcohol consumption and job displacement among older workers - Patel, Nita (Biostatistics, 2010)
The objectives of this dissertation were to compare differences in alcohol consumption among the older workers (aged 51 to 61 years) who have experienced job displacement compared to those who remain continuously employed. Generalized estimating equations were used to model this relationship using longitudinal data from the Health and Retirement Study from 1992 to 2006. Approximately 39% of respondents had died during the study period. We analyzed four models. One model excluded data for deceased respondents. Another model retained data for deceased respondents. For the remaining two models, data was imputed using multiple imputation by chained equations. Data was imputed for only the predictors in one imputation, imputed for both the dependent variable and the predictors in the second imputation. All models were weighted and adjusted for key sociodemographic variables. The results of this study show that being continuously employed, compared to experiencing job displacement, has a protective effect on the onset of alcohol consumption. Older workers who were not displaced were less likely to report consuming alcohol compared to those who had been displaced. This finding remained statistical significant even after adjusting for key sociodemographic variables. Complete case analysis and observed sample models provided biased estimates (i.e. wider confidence intervals, smaller p values) compared to the two multiple imputation models. Our findings have important public health implications. Older workers are likely to have varied participation in the labor market. They are likely to be more experienced and hold senior or management positions, thereby earning higher wages. They may be at a higher risk of layoff during uncertain economic times, such as a recession. The effects of alcohol consumption among older individuals have been shown to be negative and particularly harmful, especially in terms of ethanol toxicity. Additional studies are needed to examine the health effects of late onset of drinking among older Americans.
Keywords: Employment and Labor Force; Health Conditions and Status; Methodology

Validating Diabetes Disease Status in Claims and Survey Data. Proceedings of the 2010 International Methodology Symposium: The Interplay among Censuses, Surveys and Administrative Data - Joseph W Sakshaug; David R Weir; Lauren Hersch Nicholas (Ottawa, 2010)
Keywords: Health Conditions and Status; Methodology

Work, retirement, and well-being: Does what you did for a living influence how you feel in retirement? Women's retirement and self-assessed well-being: An analysis of three measures of well-being among recent and long-term retirees relative to homemakers - Silver, Michelle Pannor (Public Policy Studies, 2010)
This dissertation contributes to the literature on retirement and subjective well-being by focusing on two key questions using data from the Health and Retirement Study: (1) Is retiring from a job that afforded greater opportunities to engage in autonomous, creative, and/or prestigious work linked with greater well-being in retirement? and (2) Are there differences in subjective measures of well-being for women who retire relative to women who are homemakers? Based on prior research comparing workers and retirees, one might expect retirees to report relatively poor well-being (e.g. Dave et al. 2006; Doshi et al. 2008). However, analyses of a sample of respondents who make the transition from working full-time to being fully retired between 1992 and 2006, suggest that retiring from a professional occupation is related to more favorable self-assessments of well-being. The second research question focuses on women's experiences by taking advantage of a unique comparison group which exists for women retiring at the early part of this century, namely homemakers or women who did not participate in the paid labor force. Analyses of female retirees who are compared to homemakers suggest that despite the major role change they experienced, participating in the paid labor force may have been a protective factor with regard to self-assessed well-being.
Keywords: Demographics; Health Conditions and Status; Retirement Planning and Satisfaction; Women and Minorities

Aging, Demographics and Memory Study (ADAMS): Sample Design, Weighting and Analysis for ADAMS - Steven G Heeringa; Gwenith G Fisher; Michael D Hurd; Kenneth M. Langa; Mary Beth Ofstedal; Brenda L Plassman; Rogers, Willard; David R Weir (Institute for Social Research, University of Michigan, 2009)
This technical report describes the sample design, design-based weighting and analysis procedures for the Aging, Demographics and Memory Study (ADAMS), a national study that recruited Health and Retirement Study (HRS) panel members to undergo a psychometric evaluation and clinical assessment visit. Langa et al. (2005) describe the general design and methods for the ADAMS including relevant background on the HRS longitudinal sample. This document provides additional detail on the sample design for the ADAMS including a description of survey sample selection, sample attrition and nonresponse, population weights, design-based variance estimation and related topics of importance to analysts of the ADAMS data.
Keywords: Health Conditions and Status; Methodology

Childlessness, Parenthood, and Depressive Symptoms Among Middle-Aged and Older Adults - Regina M. Bures; Koropeckyj-Cox, Tanya; Loree, Michael (Journal of Family Issues, 2009)
Prior research has examined whether parenthood is associated with higher levels of well-being among older adults, but definitions of parental status have varied. The authors examine links between parental status and depressive symptoms among older adults, comparing biological and social definitions of parenthood. The study finds few differences between biological and social parenthood but substantial variation in the relationship between parental status and depressive symptoms by gender and marital status. Biologically and socially childless adults had the lowest predicted levels of depression across all marital status groups. Widowed men averaged higher levels of depression than other men. For women, the highest predicted levels of depressive symptoms were observed among never-married biological parents and formerly married women who had outlived their children. Increased sampling of less common parental subgroups and diverse kinship relations to allow for more precise classifications and the consideration of joint marital parental statuses in future research.
Keywords: Adult children; Health Conditions and Status; Methodology

Contemporary Topics in American Adult Health and Mortality: Obesity and immigration - Neil K Mehta (University of Pennsylvania, 2009)
Two contemporary topics in American health and mortality are investigated: obesity and immigration. In the first essay, I investigate mortality attributable to obesity among U.S. middle-aged adults in the Health and Retirement Study. I find that obesity is a small source of attributable mortality challenging the viewpoint that obesity will stem long-term declines in U.S. mortality. In the second essay, I address another controversial issue pertaining to obesity and mortality, namely that of period trends. Across three major U.S. data (NHANES, Framingham, and NHIS), I find systematic evidence that the effect of obesity on mortality declined during 1968-2003. This decline is entirely attributed to a declining effect of obesity on cardiovascular-specific mortality. Therefore, prior studies, which either combine periods or rely on older data, do not provide a contemporary view of the mortality effects of obesity. In the third essay, I investigate the contextual determinants of obesity. In a multilevel framework, I estimate the association between the restaurant environment and BMI. While previous literature focuses on fast food, I investigate fast food and full service restaurants as well as individual- and contextual-level socioeconomic correlates. I find that a higher density of fast food is associated with higher BMI. In contrast, a higher density of full service restaurants is associated with lower BMI, suggesting a need for research into the comparative healthfulness of foods served at different types of restaurants. In the fourth essay, I investigate migrant selection and health among U.S. immigrants from the former Soviet Union (FSU), an understudied group. Unlike other U.S. immigrants, I uncover that FSU immigrants report higher levels of physical limitations compared to U.S.-born whites (ages 50-84). I use changes in immigration policy as a "natural experiment" to investigate the health effects of migrant selection. Results indicate that FSU immigrants who arrived under stricter migration policies, and therefore were more highly selected, display lower levels of physical limitations compared to those who migrated under policies that were more lenient. I compare Russian-born U.S. immigrants to that of nonimmigrants in Russia. Results indicate a positive health selection for Russian-born U.S. immigrants from their originating population.
Keywords: Demographics; Health Conditions and Status

Controlling for Endogeneity in the Health-Socioeconomic Status Relationship of the Near Retired - Bender, Keith A.; Theodossiou, Ioannis (Journal of Socio-Economics, 2009)
Although there is a strong correlation between health and socioeconomic status (SES), the direction of causation is not empirically clear. This study a uses a two stage methodology to control for endogeneity. Using data from the U.S. Health and Retirement Study, the results show that after controlling for endogeneity, labor force status turns out to be an even more important factor in determining health than in the case where endogeneity is not controlled for. In particular, unemployment generates much higher odds for worse health as measured by both subjective and objective health measures.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status

The cumulative influences of socioeconomic status on health outcomes in late adulthood: A latent growth curve analysis - Kyung H. Kwag (Iowa State University, 2009)
The objectives of this study were to examine (a) the cumulative influences of demographic variables as well as socioeconomic status on trajectories of physical limitations, chronic diseases, and depressive symptoms, and (b) cross-domain associations of these health problems in late adulthood. This study used the data ( N = 4,374, age > 65 years) from the Health and Retirement Study (HRS), collected biennially during the period from 1998 to 2006. The results of this study indicated that SES was confounded with demographic factors, especially ethnicity/race, because most of the influences of demographic factors and ethnicity/race on health problem trajectories diminished when SES was accounted for. The results of latent growth curve analyses demonstrated long-term influences of socioeconomic status on (a) the levels (severity), and (b) the slopes (rates of change) in health problem trajectories during old adulthood. Graphical analyses revealed that the SES influences on slopes reflect (a) the diverging trajectories in physical limitations reflecting a cumulative influence of SES and (b) the persistent trajectories in depressive symptoms reflecting a parallelism in old age. In addition, the initial level of a health problem influenced the change in another health problem over time, supporting the notion of a stress-manifestation or health proliferation process over late adult years. Overall, the results showed that health problems progress over the later adulthood years as an inter-related dynamic process influenced by SES. By understanding differential influences of SES on different health outcomes in old age and the dynamic health process during this period, better health interventions and prevention programs can effectively be formulated and implemented for older adults.
Keywords: Demographics; Health Conditions and Status; Healthcare

The Effect of Body Weight on Mortality: Different countries and age groups - Yeom, Jihye (University of Southern California, 2009)
The goals of this dissertation were to examine differences in Body mass index (BMI) distribution among Japanese older adults, American older adults, and the U.S. middle-aged; to investigate which factors predict being underweight, overweight or obese among Japanese older adults and American older adults and how weight is associated with chronic diseases and ADL functioning difficulties; to determine how BMI is associated with all-cause mortality in Japanese older adults and the U.S. middle-aged and older adults; to investigate how different levels of BMI are related to all cause mortality and mortality from specific-causes considering the role of biomarkers indicating physiological risk, nutrition, and health behaviors. I found that Japanese older adults (the Nihon University Japanese Longitudinal Study of Aging) have a lower weight distribution with less dispersion than both American middle-aged (the Health and Retirement Study) and older adults (the Longitudinal Study on Aging). Second, education and income did not have an effect on BMI for older men in both countries. However, as years of education increased, both American and Japanese older women are less likely to be overweight. Also, it is interesting that underweight men and women are more likely to have ADL difficulties in the U.S. Third, for total Japanese older adults, being underweight has greater risk of death than being normal weight. For total American older adults, being overweight was associated with a reduced likelihood of dying although most of the indicators of poor health and behaviors are related to being overweight or obese. For American middle-aged persons, overweight or obese people are less likely to die than normal weight. Last, I found that overweight people had significantly higher levels of risk in many biomarkers than normal weight people (the Third National Health and Nutrition Examination Interview Survey). However, underweight people have significantly worse nutritional status and health behaviors than normal weight people. Underweight people who are 65 years and older have an increased hazard of death from all causes and an increased odds of death from cardiovascular disease than normal weight people.
Keywords: Cross-National; Health Conditions and Status; Methodology

The effect of obesity or disability on the wages on employees in employer-sponsored health insurance plans - Thomas, Megan (Public Policy, 2009)
As labor can be compensated through either wages or non-wage (fringe) benefits, employers have incentives to reduce wages of employees in response to the costs of non-wage benefits (Woodbury, 1983). Health insurance is different than most fringe benefits as costs associated with it vary substantially across different individuals in an often uniform and observable way (Levy and Feldman, 2001). Evidence of whether wage penalties are made in response to the provision of employer-sponsored health insurance (ESI) is mixed, and evidence of whether potential penalties are levied more heavily on those with expected or actual high health care costs, like those who are obese or have physical disabilities, has not been well documented. This research explores this relationship using the University of Michigan Health and Retirement Study from 2006. This research tests the hypotheses that wages are lower for full-time workers with ESI obtained through their employer than those without; lower for obese full-time workers with ESI than obese full-time without; and lower for physically disabled full-time workers with ESI than physically disabled full-time workers without. It also tests whether wages are similar between the obese and disabled, and if there are race or gender effects. The findings of this research do not support any of these hypotheses. Employer-sponsored insurance has no significant effect on wages, whether obese, disabled, or not.
Keywords: Employment and Labor Force; Health Conditions and Status; Medicare/Medicaid/Health Insurance

The effect of retirement on vigorous physical activity controlling for the socio-demographic variables of age, gender, education, income, race and perceived health status affect - Nekuda, Jayme D. (Human Sciences, 2009)
Health and Retirement Study data was used to examine the relationship between retirement and vigorous physical activity. The independent variables studied were vigorous physical activity in 1998 (T1) and retirement status in 2000 (T2). The dependent variable was vigorous physical activity in 2000 (T2). The entire sample consisted of 5,351 respondents who were in the workforce in 1998 (T1). In 2000 (T2), 4,449 reported still being in the workforce while 902 reported having retired between T1 and T2. The affect was controlled by the covariates of age, gender, education, income, race and perceived health status. These covariates together predicted approximately 16.5% to 22% of the variability in participation of vigorous physical activity. Participants in the entire sample consisted of 51.7% males, 48.3% females, average age of 59, average income of $80,558, and average years of education was 13.03. White/Caucasian individuals accounted for 82.4%, 13.5% were Black/African American and slightly over four percent reported being "Other". Those who retired between T1 and T2 consisted of 57.4% males, 42.6% females, average income of $56,828, and average years of education was 12.56. Individuals' perceived health status did not significantly change from T1 to T2 whether or not they retired. Examination found that the most significant indicator of participation in vigorous physical activity after retirement was an individual's participation in vigorous physical activity prior to retirement. There was no relationship however, between retirement status and participation in vigorous physical activity. Gender was significantly related to participation in vigorous physical activity, with men's participation being higher than women's. Perceived health status was also found to be significantly related to participation in vigorous physical activity. Those who perceived their health as excellent, very good or good were significantly more likely to participate in vigorous physical activity than those who reported their health as fair or poor. Education was negatively correlated to vigorous physical activity which contradicted the literature.
Keywords: Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction

Effects of Health Status on the Decision to Retire with Corrections for Measurement Error - Hyun, Kyung-Rae (Economics, 2009)
Many studies on the relationship between labor supply and health status generally do not illustrate a unanimous agreement on the usage of subjective and objective health due to the difficulty in employing the right measures to obtain the precise and up-to-date information on the health status of subjects in question. Thereby, to resolve this quandary, we propose two models; the first model addresses how a researcher could obtain more appropriate estimate in health measure with measurement error; the other model examines whether probabilities questions within and across waves could potentially result in another measurement error. In the first model allowing to justification bias, we found the health and financial compensation' lower and upper bounds for labor force exit and in views of bounds concept, health status plays a larger role in labor force exit than financial compensation. In the second model, we found that measurement error from survey effect has an impact on the survival probability along with the measurement errors from an inherent errors-in-variable bias by using two methods: the former employing the averaged survival probabilities and the latter incorporating the instrumental variables.
Keywords: Employment and Labor Force; Health Conditions and Status; Methodology

Esaays in Empirical Health Economics - Kaufman, Adam (University of Southern California, 2009)
These essays examine econometric models of health behavior. The first essay evaluates the Kids N Fitness program, an intervention to reduce childhood overweight and obesity. The second essay uses a Childrens Hospital of Los Angeles private dataset to examine determinants of diabetic glycemic control transitions. The third essay analyzes drinking behavior and the response to spousal death among the elderly, utilizing the Health and Retirement Study panel dataset. In each case, I analyze the health behavior choice controlling for available individual characteristics including economic variables. The models apply rigorous econometric techniques and are explicit about the underlying assumptions. I find that the Kids N Fitness program is effective at helping overweight children reduce their BMI Z Score. In addition, the analysis points towards the conclusion that more highly trained instructors do not yield improved program efficacy. I find that being a teenager negatively impacts the probability that a child will return to good diabetes control from a spell of poor control. Lastly, I find evidence that spousal death and being a widow significantly impact elderly female drinking but not elderly male drinking. The topics in these essays are generally approached from the medical literature and not the economic literature. My analyses illustrate some of the potential value of applying rigorous econometric and applied microeconomic techniques to these questions in health and healthcare.
Keywords: Health Conditions and Status

Essays in labor, health, and environmental economics - Ferris, Ann E. (University of Michigan, 2009)
The first essay examines the labor demand response of the Pacific Northwest timber industry to an environmental regulation that drastically reduced timber harvest in the region in the 1990s: protecting the northern spotted owl under the Endangered Species Act. I construct county-level measures of the local intensity of owl protection, using data on 7 million acres of federal forestland set aside as critical habitat. Difference-in-differences estimates indicate a 26 percent decline in timber employment from 1990 to 2000, approximately 17,600 timber jobs, and a 2 percent decline in timber earnings per worker. Owl-protected areas vary in size; the marginal effect of an additional protected acre on timber employment is a decline of 0.09 percent. I find mixed evidence of spillover effects. Using the Canadian province of British Columbia, a regional comparison finds a smaller loss of timber employment in the Pacific Northwest: 7,700 jobs. Taken together, these results indicate that Northern Spotted Owl protection plausibly led to a small loss of timber earnings per worker and employment. The second essay describes how parents' health is related to children's human capital accumulation and educational attainment. Using data from the Health and Retirement Study, we find evidence that children with unhealthy parents attain less education than similar children with health parents. Controlling for family assets and other background characteristics, daughters are significantly less likely to complete as many years of education as sons if their mother experiences a decline in health. The third essay describes the long-term association of poor parental health on children's labor force outcomes in adulthood. To describe this long-term association empirically we use two representative, longitudinal studies with detailed information on parents' health and children's labor force status: the Panel Study of Income Dynamics and the Health and Retirement Study. We show that adults, ages 18 to 29, whose parents reported being in poor health were less likely to be working ten years later, compared to similar young adults with healthier parents.
Keywords: Employment and Labor Force; Health Conditions and Status; Methodology; Other

Factors Associated with Sleep Disruption among Community-Dwelling Older Adults in the Health and Retirement Study - Williams, Laura L. (The University of Alabama, 2009)
The purpose of this study was to examine behavioral outcomes and sleep disruption in aging adults using data from the 2004 wave of the longitudinal Health and Retirement Study (HRS). It was hypothesized that sleep disruption is associated with behavioral outcomes and sociodemographic variables in a population-based sample. Methods. The 2004 HRS data (N=20,129) represents a cross-sectional analysis of community dwelling aging adults born in the US at or before 1923 through 1953. Data are stratified by date of birth to provide five cohorts of aging elderly. The HRS Psychosocial Leave-Behind Participant Lifestyle Questionnaire (PLBQ) was given to a random sample of participants (N=1,439; 52.5% male; 47.5% female; 91.5% White; 5.2% Black; Response Rate 76.8%) who completed the 2004 HRS wave. Portions of the HRS including age, gender, race, marital status, education, income, comorbidities, and sleep measures were matched to the subjects who completed the PLBQ. An index of sleep disruption items was computed and sleep sensitive behaviors (cynical hostility, optimism, pessimism and social participation) were computed according to instrument directions. Results. After controlling for sociodemographic variables, sleep disruption independently predicted social integration ( t =2.135, p <.0001), pessimism ( t =3.995, p <.0001), cynical hostility ( t =3.854, p <.0001), and negatively predicted optimism ( t =-4.876, p <.0001). Oldest-old adults had no greater sleep disruption than younger aging adults (? 2 =1.234, p =.872), although 59% of the oldest-old subset reported frequent waking during the night. Women reported more sleep disruption than men ( t =3.270, p <.001), but all subjects reported frequent waking during the night (Men=58%; Women=68%). Married participants reported more sleep disruption than divorced or widowed participants ( t =2.161, p =.03). Blacks had no greater sleep disruption than Whites ( t =.812, p =.417). Higher education was the most influential SES predictor for sleep disruption ( F =15.309, p <.0001), and income did not independently predict sleep disruption ( t =1.297, p =.195). Conclusion. Sleep disruption predicts negative behavioral outcomes, when controlling for sociodemographic variables. Sleep disruption was greater among women and married participants, but there were no racial differences. Education was also a strong influence on sleep disruption. Further research should examine the role of sleep disruption in other behavioral and attitudinal traits.
Keywords: Health Conditions and Status

Food Prices and the Dynamics of Body Weight - Dana P Goldman; Darius Lakdawalla; Yuhui Zheng (National Bureau of Economic Research, NBER Working Paper 15096, 2009)
A popular policy option for addressing the growth in weight has has been the imposition of a fat tax on selected foods that are deemed to promote obesity. Understanding the public economics of fat taxes requires an understanding of how or even whether individuals respond to changes in food prices over the long-term. We study the short- and long-run body weight consequences of changing food prices, in the Health and Retirement Study (HRS). We found very modest short-term effects of price per calorie on body weight, and the magnitudes align with the previous literature. The long-term effect is much bigger, but it takes a long time for the effect to reach the full scale. Within 30 years, a 10 permanent reduction in price per calorie would lead to a BMI increase of 1.5 units (or 3.6 ). The long term effect is an increase of 1.9 units of BMI (or 4.2 ). From a policy perspective, these results suggest that policies raising the price of calories will have little effect on weight in the short term, but might curb the rate of weight growth and achieve weight reduction over a very long period of time.
Keywords: Consumption and Savings; Health Conditions and Status; Public Policy

Health Events, Household Wealth and Debt Holdings: Evidence from the health and retirement study - Patryk D. Babiarz (Purdue University, 2009)
The dissertation is composed of three independent studies that examine the effects of health events on household wealth, debt holdings and health investment behavior. The first study investigates the role of the unsecured credit market as a potential mechanism for intertemporal transfers of income in times of financial hardship caused by health adversities. The ability to borrow through unsecured markets is especially important to households with low financial assets. Unfortunately, households with low financial assets have been previously characterized as particularly likely to face borrowing constraints. However, recent improvements in accessibility and generosity of credit markets can mitigate the borrowing constraints of these households. Results show that the onset of an adverse health condition is associated with an average of 9 percent increase of unsecured debt. This effect is not uniform across households. Families in the bottom quartile of financial assets borrow considerably more than households with above median financial assets. The second study builds on the theory of precautionary saving which predicts that uncertainty of future depresses consumption and increases the accumulation of wealth. This emergency wealth creates a safety net against income shocks or unexpected expenditures, such as catastrophic healthcare charges. The ownership of health insurance reduces the risk of unexpected healthcare costs. Therefore, the ownership of health insurance should reduce the strength of the precautionary saving motive. The goal of the second study is to investigate whether Medicare enrollment and household asset accumulation patterns are consistent with the theory of precautionary saving. Medicare eligibility is exogenously determined using age of the insured. Thus, Medicare enrollment does not correlate with other household characteristics that determine precautionary wealth accumulation and ownership of other types of health insurance. Findings show that non-retirement financial assets of households enrolled in Medicare are over 10 percent lower compared to households without Medicare. The third study examines returns to preventive healthcare expenditures and preventive behaviors. It is widely believed that by engaging in preventive behaviors and purchasing preventive medical services individuals reduce the probability of the future outbreak of an adverse health condition and in consequence lower future healthcare costs. Building on the assumption that the share of preventive expenditures in total out-of-pocket expenditures is higher for individuals who are in good health, the study concludes that past preventive healthcare expenditures reduce the rate of growth of future healthcare expenditures and produce favorable health outcomes.
Keywords: Adult children; Consumption and Savings; Health Conditions and Status; Net Worth and Assets

Healthy Minds in Healthy Bodies: An International Comparison of Education-Related Inequality in Physical Health among Older Adults - Jurges, Hendrik (Scottish Journal of Political Economy, 2009)
We study education-related inequality in the physical health of older adults across 11 European countries and the United States. Combining the data from Health and Retirement Study 2002, the English Longitudinal Study of Ageing 2002 and the Survey of Health, Ageing and Retirement in Europe 2004, our results suggest that education is strongly correlated with health both across and within countries. Education-related inequality in health is larger in Mediterranean and Anglo-Saxon countries than in western European countries. We find no evidence of a trade-off between health levels and equity in health. Education-related inequality in health is hardly driven by income or wealth effects (except in the United States), and differences in health behaviours (smoking) by education level contribute little to health differences across education groups. Copyright (c) 2009 The Author. Journal compilation (c) 2009 Scottish Economic Society.
Keywords: Cross-National; Demographics; Health Conditions and Status; Methodology

How Do Health Shocks Influence Retirement Decisions? - McGeary, Kerry Anne (Review of Economics of the Household, 2009)
The financial viability of the nation s Medicare and Social Security programs has come into question as older adult workers, in particular members of the baby-boomer generation, begin to voluntarily retire. Obviously, any deterioration in the health of older adults will inevitably increase pressure on the Medicare system. However, if older adults respond to changes in their health by reducing their labor supply, than this will also increase demand for the Social Security system. Using data on married and employed couples from the Health and Retirement Study (HRS), this paper determines how the labor supply of each member of a married couple is influenced by changes in the health, assets and medical expenditures of the other member of the couple. Therefore, adding to the extant literature as we determine how the labor supply of an individual responds to health shocks visited on their spouse. We find that the labor supply of both males and females is influenced by their own health shocks and health shocks suffered by their spouses.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction

The Impact of Obesity and Arthritis on Active Life Expectancy in Older American Men and Women - Sandra L Reynolds; McIlvane, Jessica M. (Obesity, 2009)
This article examines the relationship of obesity and arthritis to length of life and length of disabled life in older American men and women. Secondary data analysis is conducted on three waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (n = 7,381). Using integrated Markov chains, total, active, and disabled life expectancy in Americans aged greater than or equal to70 is estimated, with and without obesity and arthritis. Results indicate that neither obesity nor arthritis is related to the length of life for older men and women, alone or in combination. However, both conditions are significantly individually associated with increased length of disabled life in older men (1.4 years attributable to obesity; 1.2 years to arthritis at age 70; P 0.05) and women (1.7 years attributable to obesity; 2.1 years to arthritis at age 70; P 0.05). In addition, the combination of the two is significantly related to decreased active life, with nearly 50 and 60 of remaining life for 70-year-old men and women lived with disability, respectively (P 0.05). Coupled with the fact that both obesity and arthritis are growing in prevalence, these findings represent one of the few clearly negative health trends in older adults today. These results should provide incentives for health-care professionals to make concerted efforts to address both conditions in clinical settings.
Keywords: Disabilities; Expectations; Health Conditions and Status

International Differences in Longevity and Health and Their Economic Consequences - Pierre-Carl Michaud; Dana P Goldman; Darius Lakdawalla; Adam Gailey; Yuhui Zheng (NBER Working Paper, 2009)
In 1975, 50 year-old Americans could expect to live slightly longer than their European counterparts. By 2005, American life expectancy at that age has diverged substantially compared to Europe. We find that this growing longevity gap is primarily the symptom of real declines in the health of near-elderly Americans, relative to their European peers. In particular, we use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Europe. We find that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Europeans could save up to 1.1 trillion in discounted total health expenditures from 2004 to 2050.
Keywords: Cross-National; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Public Policy

Job Loss: Eat, drink and try to be merry? - Deb, Partha; William T Gallo; Padmaja Ayyagari; Jason M. Fletcher; Jody L Sindelar (NBER Working Paper, 2009)
This paper examines the impact of job loss from business closings on body mass index (BMI) and alcohol consumption. We improve upon extant literature by using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data (Health and Retirement Study). For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. Thus health effects of job loss could be concentrated among at risk individuals.
Keywords: Employment and Labor Force; Health Conditions and Status

Job Transition, Bridge Work and their Effects on Health Outcomes - Morgan, Allan (University of Massachusetts, 2009)
Using data from wave 1 and wave 2 of the Health and Retirement Study, this dissertation has two main objectives: 1) to investigate how experiencing job transition events when full-time workers are in their 50s shapes entry into bridge employment, and 2) to explore the effect of experiencing job transition events and the effect of participation in bridge work on health outcomes over time. Job transition events may be involuntary, voluntary, or health-related. Although involuntary events have been associated with adverse economic consequences and negative effects on health, many events are voluntary but their effects have not previously been explored. For workers in their 50s, findings from this study suggest entry into bridge employment is less likely after voluntary events than after involuntary events. However, experiencing any type of event significantly increases the risk of negative health outcomes over time. The key finding suggests engaging in bridge employment will have a moderating effect significantly increasing the likelihood of better self-rated health and mental health outcomes over time. During the early decades of the 21st century, economic factors and an aging workforce will increase interest in bridge employment among older workers. While some individuals will exit career jobs and move into bridge employment by default, many others will gradually transition from work to retirement by making a voluntary shift from career jobs to bridge jobs. Still others who previously left the workforce will seek to reenter in bridge jobs. Bridge employment can provide economic, social and psychological benefits for workers, as well as benefits for employers and society. However, there are public policy and employer practices that present obstacles to the growth of bridge employment.
Keywords: Employment and Labor Force; Health Conditions and Status; Public Policy

Labor Market Outcomes of Obesity among the Near-Elderly - Li, Kemeng (Wayne State University, 2009)
The objective of this study is to examine the effect of obesity labor market outcomes among the near-elderly population in the U.S.. Previous studies on the labor market outcomes of obesity mostly focused on younger population and may not fully capture the adverse effects of obesity that are developed after middle-age. This study contributes to the existing literature by focusing on the specific near-elderly population. Several aspects of labor market outcomes are examined, in particular, retirement, wage and work absenteeism. This study employed the panel data of 1992 through 2004 surveys from Health and Retirement Study, a Nationally representative survey. Study sample includes over twenty thousands working males and females between age 51 and 64. I measure obesity using Body Mass Index based on self-reported weight. Logistic model is used to estimate the effect of being obese at baseline on the probability of retirement before age 64, controlling for a set of socioeconomic factors, health variables and job-related characteristics. OLS models is used to estimate the impact of obesity on hourly wage. For absenteeism, I first use logistic model to estimate the impact of obesity on the probability of missing any day due to illness among the entire working sample. Then using the sub-sample of workers who did miss any day from work, I estimate OLS models of the number of days missed due to illness. Recognizing the potential endogeneity of obesity, I applied Hausman's endogeneity test and Instrumental Variable approach. Two Stage Residual Inclusion models were estimated for each outcome variable to compare with the models that didn't adjust for endogeneity. Models are estimated for separately by gender. Estimation results suggest that obese male and female workers receive significantly lower hourly wage and lower annual earnings than their non-obese peers. Obese male and female workers are also more likely to miss some work days due to illness. In particularly, obese female workers take off a greater number of sick days than their non-obese counterparts. Although the direct effect of obesity on retirement is not significant, I observe some indirect effect of obesity on retirement through poor health status. In conclusion, obesity affects the labor market outcomes of near-elderly workers in several aspects: Obese near-elderly workers are paid less, take more sick days, and more likely to retire early due to bad health. This study can inform policy makers of the indirect cost that obesity posed on employers and individuals in terms of reduced productivity and labor participation.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status

Measuring How Risk Tradeoffs Adjust With Income - Mary F. Evans (NBER Working Paper, 2009)
Efforts to reconcile inconsistencies between theory and estimates of the income elasticity of the value of a statistical life (IEVSL) overlook important restrictions implied by a more complete description of the individual choice problem. We develop a more general model of the IEVSL that reconciles some of the observed discrepancies. Our framework describes how exogenous income shocks, such as unexpected medical expenditures, may affect labor supply decisions which in turn influence both the coefficient of relative risk aversion and the IEVSL. The presence of a consumption commitment, such as a home mortgage, also alters this labor supply adjustment. We use data from the Health and Retirement Study to explore the responsiveness of labor force exit decisions to spousal health shocks and the role of a home mortgage as a constraint on this response.
Keywords: Health Conditions and Status; Income; Medicare/Medicaid/Health Insurance

Metabolic Syndrome and Psychosocial Factors - Tweedy, Maureen P. (University of North Texas, 2009)
Metabolic syndrome is a constellation of risk factors, including abdominal obesity, hypertriglyceridemia, low HDL cholesterol, high blood pressure, and high fasting glucose, that commonly cluster together and can result in cardiovascular disease. The prevalence of metabolic syndrome and the components that comprise the syndrome vary by age and by racial/ethnic group. In addition, previous research has indicated that the risk factors contributing to metabolic syndrome may be exacerbated by exposure to perceived stress. This study utilized data from the 2002, 2004, and 2006 Health and Retirement Study (HRS) and National Health and Nutrition Examination Survey (NHANES) data sets. It was hypothesized that depression and anxiety (conceptualized as stress in this study) increase the risk of presenting with metabolic syndrome while social support decreases the risk of metabolic syndrome. While results of cross-sectional analysis do not indicate a significant relationship between depression and metabolic syndrome ( t = -.84, ns), longitudinal analysis does indicate a significant relationship between depression and metabolic syndrome over time ( t = -5.20, p <.001). However, anxiety is not significantly related to metabolic syndrome when the relationship is examined through cross-sectional analysis ( t = -1.51, ns) and longitudinal analysis (? 2 = 13.83, ns). Similarly, social support is not significantly related to metabolic syndrome when examined in cross-sectional (? 2 = .63, ns) and longitudinal ( t = 1.53, ns) analysis. Although level of stress is not significantly related to metabolic syndrome as a whole, there is a significant relationship between stress and both triglyceride level ( t = -2.94, p = .003) and blood glucose level ( t = -3.26, p = .001).
Keywords: Health Conditions and Status

Physical Inactivity and Working Hour Inflexibility: Evidence from a U.S. Sample of Older Men - Chung-Ping A. Loh (Review of Economics of the Household, 2009)
Lack of time is the most frequently reported reason for lack of exercise. This study examines how restriction on the number of working hours affects individuals exercise decision. A structural model is constructed to describe the simultaneous decisions of employment and physical activity in the presence of working hour restriction. Using data from the 1992 Health and Retirement Study, this study finds that the working hour restriction is partly responsible for the physical inactivity among older American workers. When the working hour restriction is binding from below, an increase in the number of hours required on the job considerably reduces the probability of engaging in frequent exercise. The results imply that partial relaxation of working hour restrictions may be considered to promote frequent exercise.
Keywords: Employment and Labor Force; Health Conditions and Status; Time Use

Portfolio Choice in Retirement: Health Risk and the Demand for Annuities, Housing and Risky Assets - Yogo, Motohiro (Center for Retirement Research at Boston College Working Papers, 2009)
This paper develops a consumption and portfolio-choice model of a retiree who allocates wealth among four assets: a riskless bond, a risky asset, a real annuity, and housing. Unlike previous studies that treat health expenditures as exogenous negative income shocks, this paper builds on the Grossman model to endogenize health expenditures as investments in health. I calibrate the model to explain the joint evolution of health status and the composition of wealth for retirees, aged 65 to 96, in the Health and Retirement Study. I use the calibrated model to assess the welfare gains of an actuarially fair annuity market. The welfare gain is less than 1 of wealth for the median-health retiree at age 65, and the welfare gain is about 10 of wealth for the healthiest.
Keywords: Health Conditions and Status; Methodology; Net Worth and Assets

The Relationship between Fall Severity, Residential Adjustment, Functional Status, and Future Falls among Community Living Older Adults - Wiatrowski, Natalie Leland (University of Massachusetts, 2009)
Accidental falls are common, yet costly events among older adults which have been associated with an increased risk of disability, institutionalization, and death. As the population continues to age, the number of older adults at risk of falling is predicted to increase unless strategies are implemented to limit the risk of falling. While previous studies have explored the relationship between fall history, future fall risk, and disability there have been limited studies that have incorporated the number of falls experienced along with the occurrence of an injury and compared the outcome of these fall groups to older adults with no fall history. The objective of this quantitative study was to expand the current research and explore the longitudinal relationship between fall severity, future fall risk, and future disability among community-living older adults using the Health and Retirement Study. Additionally, this study also explored the longitudinal relationship between fall history and the decision to make residential adjustments. The study concluded that over a two year period, fall history was significant in predicting future fall risk and disability status. As baseline fall status increases in severity, the predicted probability of no future fall decreases and the predicted probability of multiple falls and/or an injurious fall increases. Experiencing multiple non-injurious falls over a two year period at baseline was associated with a subsequent ADL or IADL disability, while an injurious fall was associated with a subsequent functional limitation and ADL or IADL disability. Similarly, fall history was significant in predicting the decisions to make residential adjustments. The decision to make any residential adjustment is significant among those reporting one or more falls and at least one injurious fall, compared to non-fallers. Experiencing at least one injurious fall was the only fall history variable associated with the type of adjustment made. More specifically, persons who experienced at least one injurious fall were more likely to increase their subsequent use of personal care or adaptive equipment. The results of this study support early detection and prevention of fall risk as a strategy to decrease risk of future falls, disability, and support older adults living in the community.
Keywords: Disabilities; Health Conditions and Status; Housing

Retirement Decisions of Women and Men in Response to their Own and Spousal Health - Ilchuk, Serhii (The Pardee RAND Graduate School, 2009)
This dissertation studies the impact of individual and spousal health on the retirement decisions of both spouses in dual-earner families. The survival analysis techniques (Kaplan-Meier estimator, a Cox proportional hazards model, a Weibull specification) are used to analyze eight biennial waves (1992-2006) of the Health and Retirement Study (HRS), a nationally representative panel survey of the U.S. population over age 50. The modeling of retirement ages of both spouses and the time interval between their retirement dates provides a more accurate picture of the family retirement process than has been available in previous analyses. Of the various causes of early retirement, the onset of work disability has the biggest effect. The effect of functional disability is comparable, while major health events and chronic illnesses have smaller but statistically significant effects. The research findings also highlight the importance of correctly dating the exact timing of health deterioration to alleviate "justification bias" in empirical estimation of health effects. The estimates of the spousal health effects demonstrate that the onset of a husband's work disability can lead to an earlier age of retirement not only for the husband himself but also, through joint retirement, for his wife. This effect can be defined as a "joint early retirement" phenomenon. Husbands whose wives become ill also tend to retire at earlier ages. The "joint early retirement" phenomenon is more pronounced among families where the spouse remaining in the labor force is a low earner. The cost-of-illness estimates for indirect costs (productivity lost through an early retirement) of different health conditions are calculated at the individual and societal (adjusted for prevalence of conditions) levels. From a societal perspective, the most costly work disability conditions are those related to musculoskeletal and heart and circulatory conditions. At the individual level, the productivity losses are greatest from work disability related to heart and circulatory conditions and cancers and tumors. The total family productivity lost due to a husband's (a wife's) work disability is also estimated. The results of this dissertation have important implications for public policies related to labor force participation, Social Security reform, and health care.
Keywords: Adult children; Health Conditions and Status; Retirement Planning and Satisfaction

The Rise in Obesity Across the Atlantic: An economic perspective - Brunello, Giorgio; Pierre-Carl Michaud; Anna Sanz-de-Galdeano (Economic Policy, 2009)
We provide comparable evidence on the patterns and trends in obesity across the Atlantic and analyse whether there are economic rationales for public intervention to control obesity. We take into account equity issues as well as efficiency considerations, which are organized around three categories of market failures: productive inefficiencies, lack of information or rationality and health insurance externalities. We also calculate the long term financial consequences of current US and European obesity trends, and conclude with a brief review of current policies to reduce and prevent excessive body weight both in Europe and the US.
Keywords: Cross-National; Health Conditions and Status; Medicare/Medicaid/Health Insurance; Methodology; Public Policy

Sin Taxes: Do Heterogeneous Responses Undercut Their Value? - Padmaja Ayyagari; Deb, Partha; Jason M. Fletcher; William T Gallo; Jody L Sindelar (NBER Working Paper, 2009)
This paper estimates the price elasticity of demand for alcohol using Health and Retirement Survey data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price but the other is unresponsive. Differences between these two groups can be explained in part by the behavioral factors of risk aversion, financial planning horizon, forward looking and locus of control. These results have policy implications. Only a subgroup responds significantly to price. Importantly, the unresponsive group drinks more heavily, suggesting that a higher price could fail to curb drinking by those most likely to cause negative externalities. In contrast, those least likely to impose costs on others are more responsive, thus suffering greater deadweight loss yet with less prevention of negative externalities.
Keywords: Health Conditions and Status; Methodology; Public Policy

Socioeconomic status and health redux: New evidence from England in a comparative context - Caswell, Kyle J. (The American University, 2009)
People with higher socioeconomic status (SES) enjoy superior health. For the US, it is especially difficult to identify pathways underpinning this relationship, as it likely reflects differences in access to health care in addition to other factors correlated with SES. In England, however, access to care is universal, so that if SES is positively correlated with health, its main effects must come via alternative pathways other than access to care. This dissertation investigates the effects of SES on health outcomes, and vice versa, using the English Longitudinal Study of Ageing (ELSA). As the ELSA is similar to the US Health and Retirement Study, I compare the SES-health relation between countries. I find that the effect of SES on health is significant in England, with wealth the most important in guarding against negative health outcomes. However, for lower SES individuals, there are important differences between countries, suggesting that access to care has its largest effect among the least advantaged. Furthermore, new health events affect the economic resources of English individuals less than their US counterparts. Finally, there is evidence among married couples that wives respond to their husbands' new health conditions by increasing market labor hours--i.e., an 'added worker effect.'
Keywords: Cross-National; Demographics; Health Conditions and Status; Healthcare; Net Worth and Assets; Other; Public Policy

Successful Aging among Older Americans: Prevalence, Trends, and Disparities - Sara J McLaughlin (University of Michigan, 2009)
At the beginning of the last century, 1 in 25 Americans was age 65 or over. By 2050, however, 1 in 5 will be an older adult. Because older adults shoulder a disproportionate share of health problems, concerns have been raised about the impact that an expanding older population will have on American society. Research suggests, though, that good health in the later years is possible and that health promotion efforts may help avert some of the "costs" of a growing older population. Currently, little is known about the prevalence of healthy aging in the US. To help fill this void, Rowe and Kahn's notion of healthy aging, referred to as "successful aging," was examined. Using 1998, 2000, 2002, and 2004 data from a nationally representative study of older adults, the prevalence of successful aging was estimated for the older population as a whole and major subgroups of older adults. Additionally, trends over time in the prevalence of the phenomenon were examined to determine if the percentage of older adults aging "successfully" has changed in recent years. Guided by Rowe and Kahn's framework, successful aging was operationalized as having no difficulty with six activities of daily living, none of five chronic diseases, no more than one difficulty with seven measures of physical functioning, a median or higher score on tests of cognitive functioning, and being actively engaged. Analyses were restricted to the roughly 10,000 adults at each wave who were ages 65 and over. Results indicate that fewer than 10% of older adults were aging "successfully" in any wave. In adjusted analyses, those of lower SES, advanced age, and male gender were consistently found to have lower odds of aging "successfully" than their respective counterparts. In addition, for the most recent wave of data collection, those of non-White race/ethnicity had just half the odds of aging successfully as older White adults. Over the six-year period, the prevalence of successful aging declined by 19%, with differential trends by SES evident in 2004. The implications of these findings for the continued study and development of the concept of "successful aging" are discussed.
Keywords: Health Conditions and Status

Three Essays in Health Economics - Christina A. Robinson (North Carolina State University, 2009)
This essay examines topics in health economics. The first study uses data obtained from the Rand version of the Health and Retirement Study, to examine the relationship between retiree health insurance (RHI) and the decision to leave one's career job. This paper a Cox Proportional Hazard Model and estimates the probability that an individual disengages from their career job. Results indicate that access to RHI are significantly increases the probability of disengagement occurring. The second and third essays examine the relationship between Food Stamp Program (FSP) participation and obesity in women and children. There are two main bodies of literature that examine the effect of FSP participation on obesity, the first focuses on adults and the second on children. The literature focusing on adults finds that FSP participation is positively related to obesity in women, while no similar effect is found for children. This creates an interesting economic puzzle. The second chapter of this dissertation focuses on children and considers weight accumulation as dynamic process. To measure obesity, a child's BMI is compared to their medically ideal BMI; if FSP increases this deviation then FSP is found to increase childhood obesity. Results suggest that FSP participation does not significantly contribute to childhood obesity. The third essay considers the relationship between FSP participation and obesity in mothers. Three estimations are performed and evidence that mothers are not at an increased risk for obesity is found. I first consider a women's weight growth in the same framework employed in chapter 2 and find no significant relationship. Next, I consider how FSP participation affects the probability a mother becomes obese. Finally, I estimate the nutritional value of foods brought into FSP households controlling for the presence of children. Results from these estimations suggest that mothers are not at an increased risk for obesity due to FSP participation. Thus, it is not surprising that children who live in FSP households are not at an increased risk of obesity, and the puzzle is resolved.
Keywords: Health Conditions and Status; Income; Medicare/Medicaid/Health Insurance; Retirement Planning and Satisfaction

Three Essays on the Effects of Health Shocks - Mohanan, Manoj (Harvard University, 2009)
This dissertation examines the effects of health shocks on a variety of individual and household-level outcomes. Chapter 1 attempts to estimate the causal effects of health shocks on household economic outcomes using a quasi-experimental study design, comprising exogenous shocks sustained as bus accident injuries in India and matched unexposed drawn from travelers on the same bus routes. I find evidence of partial consumption smoothing with some negative effect on education, but no effect on food consumption. Debt was the principal mechanism used by households to mitigate effects of the shock, leading to significantly larger levels of indebtedness among the exposed. This evidence draws attention towards costly mechanisms adopted by households to smooth consumption. Chapter 2 relies on data collected as part of the same Karnataka study and seeks to understand causal relationships underlying comorbidity in physical and mental health. I find that exposure to this acute negative health event increases psychological distress by 1.5 standard deviations on the distress scale one year later. Physical Disability acts as a key mediating mechanism, accounting for 65% of the total observed effect. Indebtedness resulting from health shock did not mediate the observed association between the exposure and distress levels. Physical health events, especially acute conditions that are associated with increased disability levels, have large and significant causal effects on mental health over one year later. In Chapter 3, I examine the consequences and predictors of onset of chronic conditions in the United States using data from 8 waves of the Health and Retirement Study (HRS). I find that onset of major chronic conditions increases out of pocket expenses by about $2500 in the subsequent wave. Over the 14 year period spanning the 8 waves, the cumulative financial losses associated with a major onset in the second wave is over $68,000. I also find evidence of large reductions in the probability of working following major onsets. Further, I also find that changes in stock wealth as well as baseline asset levels are negatively associated with probability of major onsets of illness, suggesting that baseline SES levels can influence future health outcomes.
Keywords: Adult children; Health Conditions and Status

Understanding the Economic Consequences of Shifting Trends in Population Health - Dana P Goldman; Darius Lakdawalla; Pierre-Carl Michaud; Yuhui Zheng; Adam Gailey (NBER Working Paper, 2009)
The public economic burden of shifting trends in population health remains uncertain. Sustained increases in obesity, diabetes, and other diseases could reduce life expectancy - with a concomitant decrease in the public-sector's annuity burden - but these savings may be offset by worsening functional status, which increases health care spending, reduces labor supply, and increases public assistance. Using a microsimulation approach, we quantify the competing public-finance consequences of shifting trends in population health for medical care costs, labor supply, earnings, wealth, tax revenues, and government expenditures (including Social Security and income assistance). Together, the reduction in smoking and the rise in obesity have increased net public-sector liabilities by $430bn, or approximately 4% of the current debt burden. Larger effects are observed for specific public programs: annual spending is 10% higher in the Medicaid program, and 7% higher for Medicare.
Keywords: Employment and Labor Force; Expectations; Health Conditions and Status; Healthcare; Methodology; Public Policy

Adequacy of Economic Resources in Retirement and Returns-to-scale in Consumption - Michael D Hurd; Susann Rohwedder (The University of Michigan, Michigan Retirement Research Center, 2008)
Most assessments of the adequacy of retirement resources are expressed as a comparison of preretirement income to immediate post-retirement income. Yet, among couples a substantial fraction of retirement years is eventually spent by the surviving spouse living alone. To the extent that singles need less than couples to maintain the same standard of living, assessments of the adequacy of economic resources that make no adjustment for widowing will systematically misstate economic preparation. We estimate returns-to-scale parameters in spending by older households, using data from the Consumption and Activities Mail Survey and apply these to assessments of adequacy of retirement resources.
Keywords: Consumption and Savings; Health Conditions and Status; Net Worth and Assets

Alcohol demand and risk preference - Dave, Dhaval; Saffer, Henry (Journal of Economic Psychology, 2008)
Both economists and psychologists have studied the concept of risk preference. Economists categorize individuals as more or less risk-tolerant based on the marginal utility of income. Psychologists categorize individuals' propensity towards risk based on harm avoidance, novelty seeking and reward dependence traits. The two concepts of risk are related, although the instruments used for empirical measurement are quite different. Psychologists have found risk preference to be an important determinant of alcohol consumption; however economists have not included risk preference in studies of alcohol demand. This is the first study to examine the effect of risk preference on alcohol consumption in the context of a demand function. The specifications employ multiple waves from the Panel Study of Income Dynamics (PSID) and the Health and Retirement Study (HRS), which permit the estimation of age-specific models based on nationally representative samples. Both of these data sets include a unique and consistent survey instrument designed to directly measure risk preference in accordance with the economist's definition. This study estimates the direct impact of risk preference on alcohol demand and also explores how risk preference affects the price elasticity of demand. The empirical results indicate that risk preference has a significant negative effect on alcohol consumption, with the prevalence and consumption among risk-tolerant individuals being 6-8 higher. Furthermore, the tax elasticity is similar across both risk-averse and risk-tolerant individuals. This suggests that tax policies are as equally effective in deterring alcohol consumption among those who have a higher versus a lower propensity for alcohol use.
Keywords: Health Conditions and Status; Risk Taking

Body Weight and Survival: The US experience - Yu, Yan (The University of Wisconsin - Madison, 2008)
The expanding waistlines of the American population have stirred immense research and public interest in how secular changes in body weight affect population health. Big controversies and gaps remain in our understanding about excess weight and health. It remains unclear whether obesity-related excess mortality declines over age, and whether people should control and maintain weight for optimal survival. Despite overall health improvement, we do not know if the tide has lifted all boats, and people in all weight groups, fat or lean, are living longer. This dissertation analyzes the weight-mortality relationship in the US from three different perspectives. First, I use recalled weight at age 25 to classify weight status, and document for the US female population changes in the last thirty years in a variety of indicators of mortality differentials by age-25 weight. Second, I re-examine the age patterns of mortality differentials by weight concurrent with the baseline, using an age- and cohort-specific framework. Third, I apply the marginal structural model (MSM) to study the dynamic temporal process of weight, health conditions and mortality. The first two analyses use the National Health and Nutrition Examination Surveys and national mortality data, and the last analysis, the 1992-2006 Health and Retirement Study. In contrast with previous findings based on concurrent weight, mortality does not differ between the age-25 underweight and normal-weight, and is equally elevated for the age-25 overweight and obese women. Between 1976 and 2004, mortality differentials widened, and mortality reversals were observed for the overweight/obese. Overall life expectancy continued to rise because lean mortality rates declined at an unabated pace, and the majority of the population was still characterized as age-25 lean. Based on concurrent weight, the weight-mortality relationship is constant over age, but varies depending on the age of weight measurement. Excess mortality is larger for more recent cohorts. The MSM analysis suggests the diverse health implications of weight change trajectories that may not be captured by one single measure. The implications of this research are discussed.
Keywords: Expectations; Health Conditions and Status

Childlessness and Psychological Well-Being Across the Life Course as Manifested in Significant Life Events - Chang, Echo Win-Hu (University of Southern California, 2008)
The childless population in the United States is growing fast, accounting for approximately one fifth of population aged 65 and older. The combination of longevity, marital status changes, and childlessness has led to the projection that about 25% of the population aged 70 to 85 in 2030 will not have a living spouse or a living child. Surprisingly, there is relatively little documentation about the lives of childless elders. Childless people have been conspicuously ignored in social sciences, even in very pertinent fields such as adult development, aging, the life course, and the family. Among previous studies, two common shortcomings make results on childlessness and old-age well-being inconclusive: (a) treating childlessness as a static status and not considering possible changes in its meaning and impact felt in significant life events, and (b) focusing on negative aspect of childlessness at the exclusion of possible positive rewards. This dissertation added contextual variables and measured both negative and positive affects of psychological well-being. It adopts stress process model as a framework to study the effects of childlessness on psychological well-being in the events of caregiving in middle age, retirement in young-old age, and disability in advanced old age. This dissertation uses data from Health and Retirement Study. The findings indicate that childlessness by itself does not pose a negative threat to psychological well-being. The lack of a negative effect of childlessness on psychological well-being does not mean that children are not beneficial to parents. Rather, it suggests that taking the "deviant" path of childlessness, whether voluntarily or not, does not necessarily render childless persons at a greater disadvantage than parents in old age. However, one natural outcome of childlessness is the lack of biological grandchildren the benefits associated with grandparenthood. In this dissertation, grandchildren are found to have a positive influence on grandparents', and in particular grandfathers', transitions to retirement. The effects of childlessness were teased out from the impact of marital status. Possible interaction of gender, parental status, and marital status were tested. Childlessness and singlehood interacts in some cases. Childlessness poses different implications for men and women.
Keywords: Adult children; Health Conditions and Status; Healthcare; Methodology

Circumstances of Women's First Birth May Be Linked to Their Health During Middle Age - Hollander, Dore (Perspectives on Sexual and Reproductive Health, 2008)
Once women reach late middle age, their mortality and disease risks may be related to their early childbearing history, according to analyses of data from the Health and Retirement Study (HRS), which conducts periodic surveys to track participants' health, socioeconomic circumstances and family structure.1 Among U.S. women who were born in 1931-1941 and lived until at least the early 1990s, those who had first given birth as teenagers had elevated odds of dying between 1994 and 2002; they also were more likely than others to have had heart disease, lung disease or cancer by 1994. A series of logistic regression models controlling for background and midlife characteristics indicated that women who had given birth before age 20 were at increased risk of having had heart disease, lung disease or cancer by 1994 (coefficients, 0.3-0.4).
Keywords: Adult children; Demographics; Health Conditions and Status

Comparison between SHARE, ELSA, and HRS - Fernandes, M.; Erik Meijer; Gema Zamarro (First Results from the Survey of Health, Ageing and Retirement in Europe (2004-2007): Starting the longitudinal dimension, 2008)
Keywords: ELSA; Employment and Labor Force; Health Conditions and Status; Income; Methodology; SHARE

Documentation of Health Behaviors and Risk Factors Measured in the Health and Retirement Study (HRS/AHEAD) - Kristi Rahrig Jenkins; Mary Beth Ofstedal; David R Weir (Institute for Social Research, University of Michigan, 2008)
The two most important negative behaviors for population health are smoking, which is declining over time, and obesity, which is on the rise. Recognizing the important role of health behaviors and risk factors with respect to issues of key importance to the HRS (health, employment, wealth, timing of retirement), the original designers of the HRS incorporated a set of core measures of health behaviors at the outset. These measures have been expanded over time. The health behaviors and risk factors that are covered in the HRS include: Cigarette smoking (current and past behavior); Alcohol consumption (current behavior and past drinking problems); Body mass index (derived from self-reports of height and weight); Exercise (current level); Preventive health screenings. This report is organized as follows. Section II provides an inventory of the measures of health behaviors and risk factors that are covered in HRS, noting additions and changes that have occurred across waves. Special methodological issues that must be considered when using these data are covered in Section III. Section IV (and corresponding Tables 2-28) presents prevalence estimates and frequency counts for each of the health behavior and risk factor measures over time. Lastly, Section V addresses data quality by comparing HRS prevalence estimates with those from other surveys, reviewing results from some of the studies that have used HRS data to study health behaviors and risk factors, and investigating the level of missing data for these measures.
Keywords: Health Conditions and Status; Methodology

Documentation of Physical Measures, Anthropometrics and Blood Pressure in the Health and Retirement Study - Eileen M. Crimmins; Heidi M Guyer; Kenneth M. Langa; Mary Beth Ofstedal; Robert B Wallace; David R Weir (Institute for Social Research, University of Michigan, 2008)
The assessment of physical performance is an important component of the evaluation of functioning of older persons. The HRS has employed a set of standardized assessments of lung function, grip strength, balance, and walking speed. In addition, HRS collected measures of blood pressure, height, weight, and waist circumference. In 2006, HRS included the following measurements, administered in this order: Blood pressure; Lung function; Hand grip strength; Balance tests; Timed walk; Height; Weight; Waist circumference. This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions
Keywords: Health Conditions and Status; Healthcare; Methodology

Downward Trend in Dementia Linked to Better Education and Personal Wealth - Hopkins Tanne, Janice (British Medical Journal (International Edition), 2008)
Cognitive decline is declining among Americans older than 70, a study of 11,000 elderly US residents carried out at the University of Michigan Medical School has found. The study showed that higher education and higher net financial worth protected against cognitive impairment. The authors used data from the Health and Retirement Study, a nationally representative, population based longitudinal study of US adults.
Keywords: Demographics; Health Conditions and Status; Net Worth and Assets

The Economic Wellbeing of the Elderly and Divorced - Foster, Deborah (Michigan State University, 2008)
Much attention in the popular press and scholarly journals has been devoted to the economic wellbeing of the elderly and the divorced, particularly as their proportion of the U.S. population continues to grow. Amid these rising concerns, my dissertation explores some of the major risks confronting these groups. In the first chapter, I examine the extent to which long-run earnings and life events can explain the observed variation in wealth at retirement. The second chapter focuses on the wealth effects of divorce and highlights considerable differences across gender. Finally, the third chapter combines information from several data sources to gain a better understanding of trends regarding the wellbeing of the elderly in America with an emphasis on divorced women. The first chapter is motivated by the volume of recent literature examining individual retirement savings behavior. An important paper by Venti and Wise (2001) investigates how much of the observed variation in retirement wealth is attributable to differences in household lifetime earnings and life events (specifically, marital status, children, inheritances, and health). Their analysis suggests that these factors have little effect, but their data suffer from several important shortcomings, namely the use of top-coded earnings data and one-time measures of life events. I reexamine the role of long-run earnings and life events using the Panel Study of Income Dynamics (PSID) and find strikingly different results. In contrast to the meager 5% of variation Venti and Wise find is attributable to long-run earnings, my analysis with uncensored income data indicates that household long-run earnings explain over 25% of the observed variation in retirement wealth. Additionally, I find that the percent of variation explained by life events is 22% (compared to Venti and Wise's estimate of 4%) when age-varying measures are employed. Overall, my findings suggest that the explanatory power of long-run earnings and life events is over five times greater than previous estimates imply. In the second chapter, the focus shifts to the wellbeing of divorcees. It is well documented that an individual's income decreases substantially following divorce and that the decline is much greater for women than for men; however, relatively little work has examined the wealth effects of divorce. Using the PSID, we find that the wealth effects of divorce are greater for women than men. When we construct a joint measure of income and wealth to represent total financial resources, we find that women's resources fall by 24% after divorce compared to a decline of only 9% for men. We also examine the effect of divorce laws on the change in financial resources. As expected, unilateral divorce and no-fault property laws have a more significant effect on wealth than income. Significant gender differentials are also present. Given the harmful economic effects of divorce established in the second chapter, the goal of chapter three is to examine closely the wellbeing of divorcees ages 65 and older. This paper uses the Health and Retirement Study (HRS) and March Current Population Survey (CPS) to examine income, poverty, wealth, and food security for women age 65 and older and identify several important trends. For example, the poverty gap between elderly divorced and married women increased from 2:1 to 4:1 over the past four decades. Although it is evident that divorced women are worse off, it is not clear why. It could be the case that these women would have been poor regardless, but it is also possible that there something about divorce that causes economic hardship. The panel structure of the PSID helps shed some light on the issue because the same women are observed while married and after divorce. Characteristics observable when the women were married and in their 40s are able to explain only 5% of the married-divorced poverty gap, providing suggestive evidence that divorce causes an exogenous downward shift in economic wellbeing for these women. These findings imply that old age poverty alleviation policies should focus greater attention on the special circumstances of the divorced population, particularly divorced women.
Keywords: Adult children; Consumption and Savings; Health Conditions and Status

The Effect of Depressive Symptoms on Active Life Expectancy in the Presence or Absence of Chronic Conditions - Sandra L Reynolds; William E. Haley; Nonna Kozlenko (American Journal of Geriatric Psychiatry, 2008)
Objectives: The authors prospectively examined whether depressive symptoms (DS) in older adults negatively affected active live expectancy (ALE), or remaining years free of disability, and mortality, independently and in the presence of chronic diseases, and after stratification by gender. Design: Prospective cohort study, first three waves (1993-1998) of the Asset and Health Dynamics Among the Oldest Old. Setting: Data collection: University of Michigan; analysis: University of South Florida. Participants: Nationally representative sample of community-dwelling adults age 70 and older (N = 7,381). Measurements: DS (Center for Epidemiological Studies Depression, 8-item version), self-reported cancer, diabetes, heart disease, or stroke, difficulty with activities of daily living, death, and estimates of total, active, and disabled life expectancy. Results: DS reduced ALE by 6.5 years for young-old men (age 70), 3.2 years for old-old men (age 85), 4.2 years for young-old women, and 2.2 years for old-old women, and these effects remained significant at all ages and across gender even after controlling for chronic disease, the one exception being DS and cancer in old-old women. DS also reduced total life expectancy significantly, although controlling for some chronic diseases (particularly cancer and stroke) eliminated the effect of DS across age and gender groups. Conclusion: Depressive symptoms represent a serious and distinct threat to independent functioning in older adults. Whether experienced alone, or in combination with chronic diseases, depressive symptoms shorten ALE substantially. Timely diagnosis and treatment of depressive symptoms in older adults may delay the onset of disability and improve the quality of life.
Keywords: Expectations; Health Conditions and Status

The Effect of Lifecourse Socioeconomic Position and Health on Trajectories of Cognitive Function in Older Adults - Jessica Faul (University of Michigan, 2008)
Recent studies suggest that socioeconomic position (SEP) across the lifecourse may influence health, and more specifically cognitive health, through several pathways. However, few studies examining the effect of SEP on cognition have benefited from the use of longitudinal data and most have been confined to specific subpopulations of older adults or have been limited to restricted geographic areas. This overall goal of this dissertation research was to apply a lifecourse approach to the conceptualization and modeling of the social and economic determinants of cognitive performance, and attempt to further understand the relationship between disadvantage at different life stages and cognitive health in adulthood. This research uses data from the Health and Retirement Study (HRS), a nationally representative, prospective panel study of adults over 50 years of age, to: (1) estimate the effects of education and adulthood socioeconomic position on trajectories of cognitive change, (2) determine whether accumulation of socioeconomic disadvantage and social mobility from childhood to adulthood affects cognitive function, and (3) examine the association between body mass index and cognitive performance and decline in later life. These results support prior work documenting the lasting impact of education on cognition and suggest that measures of lifecourse SEP and adiposity may also be significant predictors of cognitive performance and change in older age.
Keywords: Adult children; Demographics; Event History/Life Cycle; Health Conditions and Status

The Effects of Retirement on Physical and Mental Health Outcomes - Dhaval, Dave; Rashad, Inas; Spasojevic, Jasmina (Southern Economic Journal, 2008)
While numerous studies have examined how health affects retirement, few have analyzed the impact in the reverse direction. Using the Health and Retirement Study (1992-2005), this paper estimates the effects of retirement on indicators of physical and mental health. To account for biases from unobserved selection and endogeneity, panel data methodologies are used, augmented by counterfactual and specification checks. Results indicate that complete retirement leads to a 5-14 increase in difficulties associated with mobility and daily activities, 4-6 increase in illnesses, and 6-9 decline in mental health (evaluated relative to the sample mean). The adverse health effects are mitigated if the individual is married, engages in physical activity, or continues to work part-time post-retirement. Evidence also suggests larger adverse health effects in the event of involuntary retirement. Retiring at a later age may lessen or postpone poor health outcomes for older adults, raise well-being, and reduce health care services utilization.
Keywords: Employment and Labor Force; Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

The Essays in Health and Economic Status of Elderly Married Couples - Cho, Hong Chong (University of Pennsylvania, 2008)
This study investigates similarity in health status between elderly married couples and a structural model is developed to analyze how characteristics of marriage, behavioral choices, and out-of-pocket medical expenditure allocations affect household health capital formations. The first question to answer is whether it is the case that people in good health have healthy spouses and people in poor health have unhealthy ones. I find strong evidence supporting positive spousal health similarity using the Health and Retirement Study (HRS), a data set which contains individuals born in 1931-1941 and their spouses; two waves from 1994 to 1996 are used. In the HRS, there are 5 categorized self-reported health status (excellent, very good, good, fair, and poor) which I use as a main health measure. A man who is in excellent health status in 1994 has a 34% chance to have a wife in excellent health status and has only 0.63% probability to have a wife in poor health. On the other hand, 33% of men in poor health are married to a woman in fair health and only 8% have a chance to have a wife in very good health. For women, 7% among women in poor health has a husband in excellent health and 22% of them are married to men in the same health group. A woman in excellent health has a 33% chance of being married to a man in excellent health and has a 1% chance to have a husband in poor health. When I construct a numerical ordering (1 to 5), respectively from poor to excellent in corresponding self-reported health status, the correlation coefficient is 0.27 in 1994. The concept of correlation in health status comes from Wilson (2002), which documents correlations in health status among married couples in later life and provides a simple theoretical model. While Wilson (2002) uses reduced form regression models, this study constructs a structural model and out-of-pocket medical expenditures are introduced. The second question of this study is: how can spousal resemblance in health status be explained? I explore the extent to which alikeness in health status is a consequence of resemblance in characteristics of spouses such as education and ages when couples got married, and behavioral risk factors like smoking and exercise or the result of living together. Individual characteristics at the time of marriage account for 47% of the correlation after controlling ages. Furthermore health behaviors of couples including smoking and exercise during marriage explain about 9% of the correlation. Household allocations of out-of-pocket medical expenditures and health insurances provided from their spouse affect extra 32% of the resemblance in health. The importance of direct health effects between couples during marriage are captured in the unexplained portion of the correlation. Direct health effects exist, but there is only limited evidence.
Keywords: Adult children; Health Conditions and Status

Examining the Relationships between Excess Body Weight, Health and Disability - Timothy A Waidmann; Vicki A Freedman; Christine L Himes; Ahmad, Saad (U.S. Department of Health and Human Services, 2008)
The recent rise in the prevalence of obesity and overweight in the overall United States population has raised many concerns about the future. In addition to concerns about the medical costs of treating obesity-related illness, an apparent correlation between obesity and disability has led to concern that the recent declines in rates of disability among the elderly may cease or reverse. In this report, we explore the relationship between excess weight and obesity in a series of cross-sectional and longitudinal analyses in an attempt to evaluate these concerns. Using data from the 1998-2004 waves of the Health and Retirement Study (HRS), we find evidence that the risks of developing difficulties with activities of daily living (ADLs) does increase with the prevalence of obesity, but the effects appear to be less dramatic than the effects on the limitations in physical functioning, which can be precursors of ADL disability. Further, we find only a weak relationship between excess weight and the onset of difficulties with instrumental activities of daily living (IADLs).
Keywords: Health Conditions and Status

Functional Ability and Disability among Older Adults with Arthritis: The impact of age, duration of arthritis, and severity of arthritis - Leah Rohlfsen; Jennie J. Kronenfeld (Research in the Sociology of Health Care, 2008)
Arthritis is the most prevalent chronic condition in persons ages 65 and older and is projected to increase substantially as the population ages. The purpose of this research is to assess if age, duration of arthritis, and severity of arthritis exert independent effects on various aspects of the disability process: functional limitations, activities of daily living (ADL) limitations, and instrumental activities of daily living (IADL) limitations. Type of arthritis, socio-demographic factors, behavioral factors, and additional health statuses are also examined. Using longitudinal data from the Health and Retirement study, results show age and severity of arthritis are related to the number of functional limitations one has and to the odds of having ADL and IADL limitations. Duration of arthritis is positively related to functional limitations and to the odds of reporting ADL limitations. Duration of arthritis is not significantly related to IADL limitations, which are strongly linked to performing social roles and have less to do with physical functioning compared to ADL tasks and functional tasks. There is no difference between those with established arthritis compared to those who have had it for a shorter time period, suggesting those with arthritis adapt to social tasks better than physical tasks. The resources used to cope with IADL limitations may be more effective over time compared to those used to cope with functional limitations and ADL disability. Understanding the context of functional limitations and disability among those with arthritis may lead to improved support and care for those living with arthritis.
Keywords: Disabilities; Health Conditions and Status

Gender disparities in trajectories of functional, mental, and self-rated health: An analysis of older adults - Leah Rohlfsen (Arizona State University, 2008)
Recent research has shown the disadvantage women experience in functional, mental, and self-rated health is not as uniform as once thought. Furthermore, there is a lack of research on gender differences in mental health outcomes that characterize males. Most studies are based on cross-sectional data or data from two time-points and fail to examine trajectories of functional, mental, and self-rated health. This dissertation addresses these limitations to more thoroughly understand gender differences in health. Latent growth curve modeling is used to model trajectories of functional limitations, depressive symptoms, problem drinking, and self-rated health for males and females using longitudinal data from the Health and Retirement Study (HRS) and the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). The differential exposure and differential vulnerability explanations are used to examine the extent to which an extensive set of social structural, childhood background, behavioral, and health status factors explain gender differences in health. Females have higher odds of having functional limitations and depressive symptoms, as well as have more functional limitations and depressive symptoms compared to males. Males have higher odds of problem drinking. Different factors explain gender differences in problem drinking and depressive symptoms, and the factors that cause females to be depressed differ from those that cause males to drink problematically. This suggests depressive symptoms and problem drinking are not gender-comparable outcomes. There are no gender differences in self-rated health at baseline, but females have slightly higher odds of reporting good health over time. This provides evidence of a new health paradox, in which females have the same or better self-rated health compared to males regardless of more physical limitations, acute and non-fatal chronic health conditions, and depressive symptoms. The gender differences in depressive symptoms and self-rated health are fully explained by the factors in the analysis, while the differences in functional limitations and problem drinking are only partially explained. Findings confirm the differential exposure explanation, which suggests differences exist because males and females occupy different positions in society, as well as the differential vulnerability explanation, which suggests males and females react differently to their positions in society.
Keywords: Health Conditions and Status; Healthcare

Guide to Content of the HRS Psychosocial Leave-Behind Participant Lifestyle Questionnaires: 2004 and 2006 - Philippa J Clarke; Gwenith G Fisher; House, Jim; Jacqui Smith; David R Weir (Ann Arbor, The University of Michigan, 2008)
In 2004, HRS added a new feature for data collection in the form of self-administered questionnaires that were left with respondents upon the completion of an in-person Core Interview. These are referred to as Leave-Behind Questionnaires and electronic versions of the questionnaires are included in the 2004 Final release and 2006 Early Release. The purpose of the Leave-Behind Questionnaire is to collect additional information from respondents without adding to the interview length. Two separate questionnaires on different topics were included in HRS 2004: a) Participant Lifestyle Questionnaire, which measures psychosocial issues that are described in much more detail later in this report, and b) Participant questionnaire on Work and Health, which included a series of disability vignettes in which people with various levels of physical and mental health impairment were described and respondents were asked to indicate the extent to which they think the person described is limited in the kind or amount of work they can do. At the beginning of the vignettes, respondents were asked to rate their own degree of limitation in the kind or amount of work they can do.
Keywords: Disabilities; Health Conditions and Status

Handbook of cognitive aging: interdisciplinary perspectives - Scott M Hofer; Duane F. Alwin (Sage Publications, 2008)
Keywords: Health Conditions and Status

Health status and the labor force participation decisions of married couples - Lin, Peng (University of Texas A&M, 2008)
This thesis examines the labor force participation decisions of married couples, and special attention is paid to a spouse's health conditions affecting their own and the spouse's labor force participation decision. I used the Health and Retirement Study survey data and estimated a seemingly unrelated bivariate probit model. A number of variables besides health condition were added: age, education level, and family unearned income. The results of this research paper support the findings from the relevant literature that the labor supply decisions of the husband and wife are related. The oldest age group is least likely to work. The younger the husband, the more likely it is that the husband will work. At the ages between 40 and 49, wives have the biggest probability to work. The higher the education level, the more likely it is that a spouse is going to work. The more total family unearned income, the less probable the spouse will go to work. Poor health has a negative effect on labor force participation and a positive effect for the spouse's labor force participation.
Keywords: Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction; Women and Minorities

Height, Health and Cognitive Function at Older Ages - Case, Anne; Paxson, Christina (2008)
Keywords: Health Conditions and Status

How Much Do Older Workers Value Employee Health Insurance? - Friedberg, Leora; Wei Sun; Anthony Webb (Center for Retirement Research at Boston College Briefs, 2008)
This brief seeks to answer the question in the title by analyzing data from the Health and Retirement Study (HRS), a nationally representative survey of older Americans. New questions in the HRS enable researchers to compare the value that workers place on health insurance with their perceptions about the cost of coverage.
Keywords: Health Conditions and Status; Medicare/Medicaid/Health Insurance

Kinship status and life course transitions as determinants of financial assistance to adult children - R Corey Remle (Sociology, 2008)
This dissertation contributes to the literature on intergenerational transfers by examining the dynamics of financial assistance provided by midlife parents to their adult children across the life course. This dissertation also examines whether the cumulative advantage hypothesis stretches across generational lines during co-occurring life course experiences so that financial transfers convey additional advantages to adult children. I use panel data from four waves of the Health and Retirement Study (1992, 1994, 1996 and 1998) to provide a broad picture of the process of financial assistance to younger adults within extended families. I constructed within-family trajectories of assistance to demonstrate that financial transfers are more common than previously estimated. Over 60% of all midlife-parent households gave $500 or more at least once and many parents gave multiple transfers and/or gave transfers to several adult children during a seven-year period. In an examination of kinship structures that differentiates between paternal children and maternal children within blended families, I use nonlinear logistic regression models to show that the decreased likelihood that fathers provided financial assistance to children from a previous marriage accounted solely for the reduction in transfers that all stepchildren received compared to biological children. Multilevel regression models demonstrate that transfer amounts are also influenced by kinship structures and parental resources. Additional analyses show adult child life course transitions related to schooling and coresidence were influential for parents' transfer behaviors while other life course transitions related to work, marriage, home ownership and the addition of a grandchild to the family were not influential. The number of life course transitions experienced by adult children during later waves significantly increased the likelihood of transfer receipt. However, the diversification of experiences over time made it difficult to pinpoint specific life course transitions relevant to financial assistance from parents. The strong impact of previous transfers upon the likelihood that adult children would receive transfers at later waves shows that patterns of repeated transfers were common for many intergenerational families. I argue that future research should analyze the impact of parental wealth on transfers and should explicitly examine parents' motives for giving money to adult children.
Keywords: Adult children; Health Conditions and Status; Healthcare; Methodology

A Longitudinal Analysis of the Impact of Health Shocks on the Wealth of Elders - Jinkook Lee; Hyungsoo Kim (Journal of Population Economics, 2008)
We investigate the impact of health shocks on wealth, using all four waves of the Health and Retirement Study, and estimate not only the short-term effect but also the long-term effect of health shocks on wealth of the elderly. We find that new health events lower wealth in elders during the period in which such health shocks occur, but the impact tends to disappear over time. We also find that health shocks result in greater wealth depletion when they occur later in life. Together with existing health problems, the overall impact of health problems on wealth increases over time.
Keywords: Demographics; Health Conditions and Status; Net Worth and Assets

Longitudinal study of loneliness and depression as predictors of health in mid- to later life - Chlipala, M. Linda (University of North Texas, 2008)
The longitudinal relationship between loneliness and depression as predictors of chronic health conditions in middle-aged to older adults was investigated utilizing data collected by the Health and Retirement Study (HRS), a national representative longitudinal study of health, retirement, and aging, conducted by the Institute for Social Research (ISR) Survey Research Center (SRC) at the University of Michigan, funded by the National Institute on Aging and the Social Security Administration. The correlation between these loneliness and depression was moderate ( r = .32 to r = 51). The single-item subjective self-report of loneliness was found to be an adequate measure of loneliness. A cross-lagged panel correlation and regression design was used to examine the longitudinal relationship between loneliness, depression, and chronic health conditions. A temporal precedence was indicated implying a causal relationship with depression leading to subsequent loneliness. The relationship between recurring loneliness and chronic health conditions was weak ( r = .13).
Keywords: Health Conditions and Status; Healthcare

Mortality, Heterogeneity and the Distributional Consequences of Mandatory Annuitization - Gong, Guan; Anthony Webb (Journal of Risk and Insurance, 2008)
This article investigates the distributional consequences of mandatory annuitization. Using data from the Health and Retirement Study (HRS), we calculate the relationship between socio-economic status and a utility based measure of annuity value. We find considerable variation between groups once we take account of not only socio-economic differences in mortality, but also pre-annuitized wealth and longevity risk pooling in marriage. Using HRS data on subjective survival probabilities, we then construct a subjective life table for each individual in the HRS. We show that these tables vary appropriately between groups and aggregate closely to group level averages. We calculate the value each household would place on annuitization, based on the husband and wife's subjective life tables, and the household's degree of risk-aversion and proportion of pre-annuitized wealth. A significant minority would perceive themselves as suffering a net loss from mandatory annuitization.
Keywords: Demographics; Expectations; Health Conditions and Status; Net Worth and Assets

No Pain, No Strain: Impact of Health on the Financial Security of Older Americans - Hyungsoo Kim; Lyons, Angela C. (The Journal of Consumer Affairs, 2008)
This study uses data from the 2002 and 2004 Health and Retirement Study to investigate the impact that new and existing health problems have on the financial strain of older Americans. Two-period models are estimated for a series of financial ratio guidelines that take into account household solvency, liquidity, and investment asset accumulation. We test our models using a subjective measure of self-reported health status and two objective measures of health that control for the severity of specific health conditions. The results show that health problems significantly increase the likelihood of financial strain for older individuals, but the effects vary by the measure of financial strain used and how health status is defined. Specifically, existing health conditions were more likely to affect solvency and investment asset accumulation than liquidity, while new health events were more likely to affect solvency. The severity of the condition did not seem to matter as much as whether the condition was chronic. These results provide insight into the future financial security of older Americans and have important implications for health policy and research.
Keywords: Health Conditions and Status; Net Worth and Assets

Race/ethnic differences in cognitive decline: Results from the health and retirement study - Kala M. Mehta; Lisa L. Barnes; Roland J. Thorpe Jr.; Eliseo J Perez-Stable; Kenneth E Covinsky; Kristine Yaffe (Alzheimer's and dementia : the journal of the Alzheimer's Association, 2008)
Background: As the minority population and dementia prevalence are rapidly growing, understanding cognitive decline in racially diverse elders is an increasingly important public health issue. Our goal was to evaluate whether cognitive decline occur at an accelerated rate for persons of non-White race/ethnicity (African American, Latino) compared to White older adults. Methods: Participants were from the US-representative Health and Retirement Study (HRS) 1998-2004. Cognitive assessment consisted of immediate and delayed free recall as well as serial 7s test, orientation, and naming for a total score of 35 points. Our primary outcomes were biennial cognitive change from 1998 to 2004 and cognitive decline defined as 5 point decline from 1998 to 2004. We calculated change in cognition, odds of cognitive decline, and evaluated mediators by race/ethnic group using mixed effects regression and logistic regression models. Results: The 5,552 HRS participants (mean age 72 6 years, 60 Female, 10 African Amercan, 6 Latino) had an average cognitive decline of 2.1 4.3 points over the 6 year study period. Overall, 33 of African Americans declined, 28 of Latinos declined and 26 of Whites declined. After controlling for age, gender, educational level in years, socioeconomic factors (total net worth and current income), self-reported medical comorbidity (self reported medical history of hypertension, heart disease, diabetes and stroke), and baseline cognition, African Americans were more likely to decline compared to Whites (OR 2.2; 95 CI 1.7-2.7). Latino older adults were similar to Whites in odds of cognitive decline (OR Latino 1.3; 95 CI 0.9-1.7). Conclusions: African American adults aged 65 and above were more likely to experience cognitive decline compared to White older adults after accounting for demographics, socioeconomics, comorbidity, and their baseline cognitive function. There was no difference between Latino older adults and Whites in rates of cognitive decline. Future research to identify ways to reduce cognitive decline, particularly for racially-diverse groups, are needed.
Keywords: Health Conditions and Status

Racial and Ethnic Differences in Undiagnosed and Poorly Managed Diabetes and Hypertension: Combining Population Surveys with Biomarker Data (HRS2006). - David R Weir; Eileen M. Crimmins (The Gerontologist, 2008)
CA Diabetes and hypertension are common conditions of aging that increase risk for cardiovascular events if not properly treated.Concerns about undiagnosed, and inadequately treated disease, are particularly strong for minority populations.Diabetes diagnosis rates vary from 16 among whites to 29 for blacks and 27 for Hispanics.
Keywords: Demographics; Health Conditions and Status

The relationship of diabetes and working memory: Results from the health and retirement study, 1998-2006 - Linda A. Wray (ANNALS OF BEHAVIORAL MEDICINE, 2008)
Keywords: Health Conditions and Status

Retirement and Weight - Dana P Goldman; Darius Lakdawalla; Yuhui Zheng (RAND, 2008)
Retirement from physically demanding work has long served as a healthful respite from backbreaking labor, even if it came too late in life for many. In today s era of expanding waistlines and increasingly sedentary jobs, however, leaving a physically demanding occupation may produce less healthful outcomes. We find that, during the first six years of retirement, males retiring from strenuous jobs appear to gain weight, while those retiring from sedentary jobs lose it. In particular, retirees from strenuous jobs gain approximately 0.5 more units of BMI, and exhibit relative declines in total exercise. The empirical facts suggest both a direct reduction in job-related exercise, and behavioral substitution towards more leisure-time exercise after retirement. Changes in food intake appear to play little to no role. Finally, the evidence suggests that those retiring from strenuous jobs are at least 25 more likely to contract diabetes in their retirement years. This is consistent with the negative health impacts of weight gain and reduced exercise.
Keywords: Employment and Labor Force; Health Conditions and Status

The Retirement Consumption Puzzle: Actual Spending Change in Panel Data - Michael D Hurd; Susann Rohwedder (NBER Working Paper, 2008)
The simple one-good model of life-cycle consumption requires that consumption be continuous over retirement; yet prior research based on partial measures of consumption or on synthetic panels indicates that spending drops at retirement, a result that has been called the retirement-consumption puzzle. Using panel data on total spending, nondurable spending and food spending, we find that spending declines at small rates over retirement, at rates that could be explained by mechanisms such as the cessation of work-related expenses, unexpected retirement due to a health shock or by the substitution of time for spending. In the low-wealth population where spending did decline at higher rates, the main explanation for the decline appears to be a high rate of early retirement due to poor health. We conclude that at the population level there is no retirement consumption puzzle in our data, and that in subpopulations where there were substantial declines, conventional economic theory can provide the main explanation.
Keywords: Event History/Life Cycle; Health Conditions and Status; Retirement Planning and Satisfaction

Self-Reported Vision, Upper/Lower Limb Disability, and Fall Risk in Older Adults - Bernard A Steinman (Journal of Applied Gerontology, 2008)
The purpose of this study was to examine independent and interactive roles of self-reported vision status and upper and lower limb disability as predictors of falls in people 65 and older. Data from the 2002 and 2004 panels of the Health and Retirement Study were analyzed using binary logistic regression. Results indicated a reduced or eliminated role of vision status after upper and lower limb disabilities were controlled. Gender differences were found with respect to health conditions that predicted falls; however, vision status was not found to have a moderating influence on upper and lower limb disability in predicting falls for men or women. Implications for exercise programs designed for older people with visual impairments are discussed.
Keywords: Health Conditions and Status

Socializing Appears to Delay Memory Problems - Lott, joshua (New York Times, 2008)
Keywords: Health Conditions and Status

Socioeconomic Differences in Old Age Mortality - Rasmus Hoffmann (The Springer series on Demographic Methods and Population Analysis, 2008)
Social differences in health and mortality constitute a persistent finding in epidemiological, demographic, and sociological research. This topic is increasingly discussed in the political debate and is among the most urgent public health issues. However, it is still unknown if socioeconomic mortality differences increase or decrease with age. This book provides a comprehensive, thoughtful and critical discussion of all aspects involved in the relationship between socioeconomic status, health and mortality. In a well-written language, it synthesizes the sociological theory of social inequality and an empirical study of mortality differences that has been performed at the Max Planck Institute for Demographic Research (Rostock, Germany). The best available datasets from Denmark and the USA, as two very different countries, are used to analyze the age pattern of social mortality differences, the Danish register data covering the whole Danish population between 1980 and 2002. This study is the most comprehensive analysis of socioeconomic mortality differences in the literature, in terms of data quantity, quality, and the statistical method of event-history modeling. It makes important new theoretical and empirical contributions. With a new method it also addresses the question whether the measurement of social mortality differences in old age so far has been biased by mortality selection due to unobserved heterogeneity.
Keywords: Demographics; Health Conditions and Status

Anticipated Longevity and Other Determinants Shaping Parent-Child Proximity for Older Americans - Zhang, Yiduo (The Johns Hopkins University, 2007)
Background. The family has been a consistent source of care for older Americans. Proximity among family members is an increasingly salient factor in determining how easy or difficult it may be for family members to care for each other currently or in the future. However, studies examining families' decisions regarding proximity, particularly that between older parents and their children (intergenerational proximity), are lacking. The purpose of this study is to investigate the decision-making process surrounding intergenerational proximity, with an emphasis on the role played by anticipated future needs for family support as well as the costs and benefits associated with living in close proximity to members of other generations within the family. Methods and Data. We set up an economic framework to reflect the impact of anticipated longevity and the expected costs and benefits of close intergenerational proximity for older parents and their children. Using a nationally representative sample of older people from a large scale data set (the 2000, 2002 and 2004 waves of the Health and Retirement Study), we implemented multivariate regression analysis to test hypotheses developed from theoretical models reflecting the decision-making process from both the parents' and the children's perspectives. Results. Older individuals with greater anticipated longevity are more likely to relocate and move closer to their children, holding other things equal. Factors that reflect the costs of moving (e.g., home ownership) or the costs of providing service to other family members (e.g., labor force participation, greater wage earnings), or both (e.g., having established one's own nuclear family) diminish the probability that the focal person in a given analysis (either a parent or an adult child) will live nearby or move closer to a member of the other generation. Factors that reflect potential gains from living in close proximity to other family members (e.g., health care needs that could be met by familial caregiving and potential financial benefits) increase the probability that the focal person will live nearby or move closer to the other generation. Conclusion. American families appear to balance the expected costs and benefits of intergenerational proximity within a given time horizon. These findings provide empirical support for the economic model of decision-making regarding families' residential proximity. This is a promising approach to classifying family and individual characteristics into categories of costs and benefits and to investigating their impacts and inter-relationships within a particular time horizon.
Keywords: Adult children; Demographics; Health Conditions and Status

Are Baby Boomers Living Well Longer? - David R Weir (Redefining Retirement: How Will Boomers Fare?, 2007)
This chapter uses the Health and Retirement Study to describe the relationship between work and health for older persons by age. We examine not only the patterns within a given cross-section, but also we study trends in health at ages 51-56 between 1992 and 2004. Most retirement occurs well before the onset of work-limiting disability, leaving a large reserve of potential for longer worklives. Baby Boomers will likely have to draw on this reserve, yet its health is not demonstrably better than that of persons born a dozen years earlier. Nevertheless, advances in medical care for health conditions that most 51-56 year olds have not yet encountered may still yield better health at older ages for the Boomer cohort.
Keywords: Expectations; Health Conditions and Status; Other

The Correlates of Cognitive and Metacognitive Stability and Change in the First Five Waves of the Health and Retirement Study (1992-2000) - Robnett, Regula H. (University of Massachusetts, Boston, 2007)
This dissertation explores the correlates of cognition and metacognition over the first five waves of the longitudinal Health and Retirement Study (HRS) out of the University of Michigan. The HRS is a national data base primarily concerned with health and retirement issues of those who were aged 51 to 61 in 1992. A new wave was completed every two years. Using multinomial logistic regression analyses various sociodemographic, health, lifestyle, and baseline, early-wave cognitive functioning variables were viewed as potential predictors of later-wave cognitive functioning four or eight years later and for trajectories of memory performance over the five waves. Several of the demographic and former cognitive functioning variables tended to be robust predictors of future cognitive functioning. Exerting a consistently negative influence were being male, an increase in depression symptoms, and self-reported Instrumental Activities of Daily Living impairments (specifically map-reading). Positive influences were exerted by being in the white racial group, higher educational levels, self-perceived better health, and higher baseline memory, analogies, and vocabulary scores. The current project lays the foundation for future exploration of the correlates of cognitive impairment, including dementia, as this population group heads into their seventh decade.
Keywords: Health Conditions and Status; Methodology

Cross-Cohort Differences in Health on the Verge of Retirement - Beth J Soldo; Olivia S. Mitchell; Tfaily, Rania; John McCabe (Redefining Retirement: How Will Boomers Fare?, 2007)
Baby Boomers have left a unique imprint on US culture and society in the last 60 years, and it might be anticipated that they will also put their own stamp on retirement, the last phase of the life cycle. Yet because Boomers have not all fully retired, we cannot yet judge how they will fare as retirees. Instead, we focus on how this group compares with prior groups on the verge of retirement, that is, at ages 51-56. Accordingly, this chapter evaluates the stock of health which Early Boomers bring to retirement and compare these to the circumstances of two prior cohorts at the same point in their life cycles. Using three sets of responses from the Health and Retirement Study, we find some interesting patterns. Overall, the raw evidence indicates that Boomers on the verge of retirement are in poorer health their counterparts 12 years ago. Using a summary health index designed for this study, we find that those born 1948 to 1953 share health risks with the War Baby cohort. This suggests that most of the health decline instead began before the late 1940's. A more complex set of health conclusions emerges from the specific self-reported health measures. Boomers indicate they have relatively more difficulty with a range of everyday physical tasks, but they also report having more pain, more chronic conditions, more drinking and psychiatric problems, than their HRS earlier counterparts. This trend portends poorly for the future health of Boomers as they age and incur increasing costs associated with health care and medications. Using our health index, only those at the 75th percentile or higher are likely to be characterized as having good or better health.
Keywords: Health Conditions and Status; Other; Retirement Planning and Satisfaction

Cross-Country Variation in Obesity Patterns among Older Americans and Europeans - Pierre-Carl Michaud; Arthur H.O. vanSoest; Andreyeva, Tatiana (Forum for Health Economics and Policy (Aging and Medical Care Costs), 2007)
While the fraction of obese people is not as large in Europe as in the United States, obesity is becoming an important issue in Europe as well. Using comparable data from the Survey of Health, Aging and Retirement in Europe (SHARE) and the Health and Retirement Study in the U.S. (HRS), we analyze the correlates of obesity in the population ages 50 and above, focusing on measures of energy intake and expenditure as well as socio-economic status. We find that obesity rates differ substantially on both sides of the Atlantic and across European countries, with most of the difference coming from the right tail of the weight distribution. The well-known SES gradient in the prevalence of obesity differs across countries and cannot be fully explained by the variation in food expenditure or physical activity. Obesity is associated with lack of physical activity, calorie intake, time spent on cooking, and time and money spent on eating at home and away from home, but some of these associations vary across countries. More research is needed to analyze why this is the case.
Keywords: Cross-National; Demographics; Health Conditions and Status; SHARE

Disease prevalence and survey design effects: A response to Weir and Smith - Sven E. Wilson; Benjamin L. Howell (Social Science and Medicine, 2007)
Evidence provided by Weir and Smith, particularly the findings from the National Health and Nutrition Examination Survey (NHANES), leads us to conclude that an increase in arthritis prevalence during the 1990s in the United States is probable, but the trend is likely overstated in the Health and Retirement Study (HRS). We show that a mistake in our earlier method does not change substantively our previous conclusion that survey duration effects are occurring in the HRS, a finding that is also supported by a variety of regression models (including that of Weir and Smith). Furthermore, very little evidence exists for an upward trend among self-reporters in the National Health Interview Survey (NHIS), and less than 25 of the increase in the HRS over the 1990s can be attributed to increases in obesity.
Keywords: Health Conditions and Status; Methodology

Do the Sick Retire Early? Chronic illness, asset accumulation and early retirement - Miah, M. Solaiman; Wilcox-Gök, Virginia (Applied Economics, 2007)
Our objective is to determine how chronic illness affects asset accumulation and retirement. Previous studies have found that poor health leads to early retirement, but those studies failed to look at the indirect impact of chronic illness on retirement. Using data from the Health and Retirement Study, we define an illness as chronic if the individual reports having asthma, cancer, heart disease, stroke or diabetes for four or more years. We first estimate how a chronic illness influences asset accumulation. We then estimate how asset accumulation and current poor health influence retirement. We observe that the vast majority of the chronically ill population do not report their general health to be poor nor do they report functional limitations in activities of daily living. Nevertheless, our results indicate that chronic illness leads these people to accumulate fewer assets during their working years and consequently retire later. Neither researchers nor policymakers discussing the many critical issues surrounding illness and retirement have addressed this issue.
Keywords: Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction

The Effect of Health and Health Risk Factors on Non-Housing Wealth and Medical Expenses - Rodriguez-Flores, Alicia (Purdue University, 2007)
The purpose of this study was to investigate the effects of health conditions and health risk factors on non-housing wealth changes of older adults. The research was based on Grossman's economic model of health which proposes that health stock is determined by the individual's current and past inputs and behavior. The 4 th and 6 th waves of the Health and Retirement Study were used to examine the relationship between health problems and health risk factors and the percentage change of non-housing wealth, out-of-pocket medical expenses, and total medical expenses. For couples, changes in non-housing wealth were negatively related to a head of household who abused alcohol, and to a spouse who smoked; wealth changes were positively related to a spouse who was physically active. For single individuals, mild health conditions were negatively related to wealth changes; problem drinking was positively related to changes in non-housing wealth. Out-of-pocket and total medical expenses were also influenced by health conditions and health risk factors. In summary, this research revealed that health risk factors can affect total wealth as well as increase medical expenses. Those who advise consumers in regard to wealth accumulation should include the effect of health and health risk factors. Similarly, those who advise consumers with regard to health and health risk factors should include guidance about the effect of healthy behaviors on wealth.
Keywords: Health Conditions and Status; Net Worth and Assets

Effect of Retirement on Eating Out and Weight Change: An Analysis of Gender Differences - Chung, Sukyung; Barry M Popkin; Marisa E Domino; Sally C. Stearns (Obesity, 2007)
OBJECTIVES: The objectives were to understand how the retirement decisions of older Americans influence household food consumption patterns by gender and, in turn, to examine the impact of the change in food consumption on weight. RESEARCH METHODS AND PROCEDURES: This study used five waves of the Health and Retirement Study (1992 to 2002; n=28,117). Participants were 50 to 71 years old during the study period. We used longitudinal regression analyses controlling for health events, spousal factors, socioeconomic factors, and individual fixed effects over time. RESULTS: Retirement of the individual and of his/her spouse reduced the individual's monthly spending on eating out by 10 and 7 on average, respectively, but did not change household spending on food at home. The wife's, but not the husband's, retirement decreased the spouse's spending on eating out by 13/mo. Spending on eating out was a significant but weak (0.003BMI/ ) predictor of weight gain. DISCUSSION: The decrease in spending on eating out after retirement, particularly women's, suggests that people eat out less when they have more time for food preparation at home. However, increases in other risks of weight gain with retirement, such as physical inactivity, could counteract the effects of eating out less.
Keywords: Consumption and Savings; Demographics; Health Conditions and Status; Retirement Planning and Satisfaction

Effects of Retirement on Health among Men and Women in the Health and Retirement Study - Fondow, Meghan Dee Miller (The Ohio State University, 2007)
The myth of retirement and health states that health declines following retirement. Previous studies examining the veracity of this myth offer contradictory findings and varied methodologies. Several studies have found support for the myth, but others have found that health may actually improve in retirement. Also, it has been suggested that retirement may affect health of men and women in different ways. The purpose of the current study was to clarify and extend previous findings regarding the relationship between retirement and health among men and women using data from the Health and Retirement Study. The study was conducted in two phases. For the first phase, cross-sectional data were analyzed with working and retired participants matched on age, sex, race, and education. In the second phase, a longitudinal matched sample was utilized that included working participants, half of whom had retired by four year follow up. Sex, marital status, and income were examined as potential moderators. Results indicated that retired participants in both samples reported more functional health impairment and more symptoms of depression. However, the effect appeared to be evident primarily among people who had been forced to retire. There was no difference between voluntary retirees and working participants on functional health impairment, and voluntary retirees actually reported fewer symptoms of depression than working participants. Overall, this study provides support for the myth of retirement and health, but only among people forced to retire.
Keywords: Demographics; Health Conditions and Status; Retirement Planning and Satisfaction

Essays in Labor Economics: Alcohol consumption and socioeconomic outcomes - Sarpong, Eric (Economics, 2007)
Recent studies indicate that alcohol consumption may affect socioeconomic outcomes through its effects on health capital and social capital. If, in fact, differences in socioeconomic outcomes are causally linked to differences in alcohol consumption, then lack of adequate insight into such connectivity may adversely affect the labor market and retirement outcomes of some groups of individuals in society. The rationale for examining the relationship between alcohol consumption and socioeconomic outcomes stems from growing concerns about deterioration in retirement outcomes resulting from declining health capital and recent shifts to incorporate social capital as a key performance or productivity indicator by employers. In two essays, this research examines the impact of alcohol consumption on wealth at retirement using data from the RAND Health and Retirement Study (HRS) from 1992 through 2002; and the effects of alcohol consumption on employment duration and earnings using the Geocode version of the National Longitudinal Survey of Youth (NLSY1979) micro dataset from 1984 through 1996. The theoretical foundation of the association between alcohol use and economic outcomes relies on Grossman's (1972) health capital model. Empirically, the research relies on panel data methods and duration analysis to determine whether differences in socioeconomic outcomes can be explained by differences in alcohol consumption. Using both duration analysis and panel data methods, the results indicate that drinking is positively related to improved socioeconomic outcomes as compared to total abstention, when endogeneity has not been taken into account. In contrast, under the duration analysis, estimation via instrumental variables approach indicates that alcohol consumption shortens employment duration. Panel data estimation indicates that the relationship between alcohol consumption and socioeconomic outcomes is rather an inverted U-shaped for some specifications, when endogeneity has been taken into account. Additionally, the effects of drinking on retirement wealth and earnings tend to diminish with the instrumental variables approach. The findings were unchanged even with abstainers partitioned into lifetime abstainers and infrequent or light drinkers (less than one drinking day per week). The results also confirm the positive association between human capital measures such as the level of education and economic outcomes and also the negative relationship between alcohol consumption and taxes on alcoholic beverages. This dissertation contributes to the literature on alcohol-socioeconomic outcomes nexus and has implications for policies related to health, social capital and alcohol since a more inclusive alcohol and/or health policy could improve civic responsibility and narrow the health capital and social capital gap, both of which are critical to individual level socioeconomic success.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Net Worth and Assets

Essays on Optimal Portfolio Choice and Unemployment Insurance - Luo, Jia (University of California, Los Angeles, 2007)
This dissertation consists of two essays exploring optimal portfolio choice over the life cycle and optimal unemployment insurance program. The first essay explores the effects of uninsurable risk of health expenditures as well as labor income risk on portfolio choice in a realistically calibrated life-cycle model. Most of the existing literature that examines labor income risk and its effect on portfolio composition cannot explain continued declines in risk-taking with age after retirement. This paper uses MEPS (Medical Expenditure Panel Survey) and HRS (Health and Retirement Study) data to calibrate uncertain medical expenses for the retired. With the consideration of idiosyncratic health expense risk in addition to labor income risk, the model can generate declining financial risk-taking with age after retirement, and therefore fits the data much better than those studies which consider labor income alone. Additionally, regressions on simulated data also show that investors with poorer health tend to hold a smaller share of stocks in their portfolios, which is consistent with the empirical pattern of portfolio choice. Finally, using the model I have developed, I predict the impact of changes in government health insurance programs, such as the expansion of the Medicare program, on individuals' portfolio choices. Simulated results show that a more generous Medicare policy significantly increases the proportion of financial wealth held in equities for the retired. The second essay proposes the optimal design of the unemployment insurance contract in an environment with consumption commitments in which people cannot substitute freely among different goods within a single period. The optimal plan I obtain involves a relatively flat decreasing sequence of insurance payments over some duration, which is then followed by a large drop to a very low level of transfer. The results fit current policy well, and therefore give an explanation to justify the current policy. Additionally, the model predicts that if we change from the current unemployment program to the optimal contract, the government will only save 1.7% in unemployment payments, which shows that current policy is not as flawed as researchers have traditionally believed. In fact, to achieve efficiency, the efficient unemployment transfers should include a jump, similar to what we observe in practice.
Keywords: Employment and Labor Force; Health Conditions and Status; Net Worth and Assets

Growing Older in America: The Health and Retirement Study (US Department of Health and Human Services, 2007)
Growing Older in America: The Health and Retirement Study describes the breadth and depth of the HRS to help familiarize a broad range of researchers; policymakers; media; and organizations concerned with health, economics, and aging with this data resource. Published in 2007, this colorful data book describes the HRS's development and features and offers a snapshot of research findings based on analyses of the Study's data. Sections of the report look at older adults health, work and retirement, income and wealth, and family characteristics and intergenerational transfers. More than 65 figures and tables illustrate the text.
Keywords: Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction

Immigrant Status, Health, and Mortality in Later Life - Woo, Hae-bong (The University of Texas at Austin, 2007)
Given the growing importance of the immigrant population in the United States, identifying the determinants of immigrant health following migration is critical to understanding the impact of international migration on the health of the nation. Using the Health and Retirement Study (HRS), this study examined nativity differences in mortality and physical functioning in later life, with special attention to (1) the determinants of nativity differences in mortality and physical functioning and (2) the association between mortality and disability in terms of the compression of morbidity paradigm. This study found that immigrant men had lower mortality compared to their U.S.-born counterparts of similar racial/ethnic backgrounds. However, immigrant women were indistinguishable from U.S.-born women of similar racial/ethnic backgrounds. With respect to physical functioning, immigrants showed lower levels of functional limitations but were indistinguishable from U.S.-born residents of similar racial/ethnic backgrounds in terms of disability. The data also showed that the effect of immigrant status somewhat differs across mortality and physical functioning. While all foreign-born racial/ethnic minorities showed lower or comparable mortality risks compared to native-born whites, foreign-born Hispanics showed poorer functional health than native-born whites. This study also found that socioeconomic status, social integration, and health behaviors play important roles in explaining the observed nativity differences in mortality and physical functioning. In particular, compared to prior research, the results indicate that socioeconomic factors better explain the observed nativity differences in mortality and physical functioning compared to social integration and health behaviors. This study also illustrated that integrating mortality and disability is a valuable way to investigate immigrant health. Compared to U.S.-born residents, the analysis of active life expectancy revealed that mortality is loosely coupled with disability for immigrants and that, except for foreign-born whites, immigrants' lengthy lives are expected to be a prolonged period of disability. Overall, the results indicate that immigrant's socioeconomic adaptation into U.S. society has a great impact on immigrant health in later life. This study also suggests that social policies aimed at promoting immigrant health need to be accompanied by a more general effort to integrate immigrants into U.S. society.
Keywords: Demographics; Health Conditions and Status

The Impact of Retirement on Trajectories of Physical Health of Married Couples - Angela L Curl (Applied Social Sciences, 2007)
Retirement's impact on health in married couples is important due to increasing life expectancy and the retirement of Baby Boomers. There is mixed evidence about retirement's effects, if any, on physical health. In addition, there is a lack of research that examines the effect of one spouse's retirement on the other spouse's health. Secondary analysis was conducted using longitudinal data from the Health and Retirement Study (HRS), which was designed to obtain information about health and economic status from pre- to post-retirement. The sample consisted of 1,666 non-Hispanic married couples (176 Black couples and 1490 White couples) where both spouses participated in HRS from 1992 to 2000 and at least one spouse was age 51-61 at baseline. Political economy, social stratification, and interdependence theories provided the conceptual framework. Multilevel modeling was used to analyze spouses' short-term and long-term changes in health after retirement. Health was measured using four separate indicators (number of disease diagnoses, lower body difficulties, self-rated health, mortality). Retirement was operationalized two ways: self-defined retirement and labor force status (working, retirement, unemployed, disabled). Other predictors were demographics, health-related control variables and household characteristics. Husbands experienced an increase in their number of disease diagnoses and their risk of having at least one lower body difficulty (e.g., difficulty walking up a flight of stairs) during the first wave of their retirement, but fewer disease diagnoses long-term (i.e., up to 8 years post-retirement), compared to non-retired husbands. Wives experienced worse self-rated health during the first wave of their own retirement. Wives' retirement had a short-term positive impact on the self-rated health of husbands, but husbands' retirement did not affect wives' health. The health of certain individuals was more negatively affected by retirement than others due to their social stratification characteristics (race, education, income, wealth, age). Health disadvantage was predicted by both higher and lower social status (depending on gender, health outcome, retirement measure, and length of time since retirement). Findings of this study are important for social workers helping married couples through retirement transitions, for furthering empirical knowledge and research methodology, and for their implications for social justice and policy reform. Indexing (document details)
Keywords: Adult children; Health Conditions and Status; Retirement Planning and Satisfaction

Job Characteristics and the Psychological Well-being of Older Workers - Shattuck, Anne M. (Sociology, 2007)
Changes in public and private pensions as well as demographic and economic changes will likely lead to higher labor force participation rates for older adults in the future. Little research has examined the impact of work on the well-being of older adults beyond simply comparing those who work with those who do not. Using data from the 2002 and 2004 waves of the Health and Retirement Study, this thesis examined whether specific job characteristics--namely job flexibility, job stress, and the workplace climate's friendliness to older workers--were associated with depressive symptoms among a group of workers aged 62 to 73. Cross-sectional analyses indicated that job stress and workplace climate were associated with depressive symptoms. Longitudinal analysis revealed that workers whose employers would permit older workers to move to less demanding jobs showed decreases in depressive symptoms across survey waves compared with those who could not make such a move.
Keywords: Employment and Labor Force; Health Conditions and Status; Healthcare

Living Rationally Under the Volcano? An Empirical Analysis of Heavy Drinking and Smoking - Arcidiacono, Peter; Sieg, Holger; Frank A Sloan (International Economic Review, 2007)
This study investigates whether models of forward-looking behavior explain the observed patterns of heavy drinking and smoking of men in late middle age in the Health and Retirement Study better than myopic models. We develop and estimate a sequence of nested models that differ by their degree of forward-looking behavior. Our empirical findings suggest that forward looking models fit the data better than myopic models. These models also dominate other behavioral models based on out-of-sample predictions using data of men aged 70 and over. Myopic models predict rates of smoking for old individuals, which are significantly larger than those found in the data on elderly men.
Keywords: Health Conditions and Status; Methodology; Risk Taking

Mammography Use among Older Women in the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study - Thomas R Miller (University of Iowa, 2007)
Mammography is an accepted secondary prevention tool for detecting breast cancer, the second leading cause of cancer deaths among women. Although Medicare began covering screening mammography in 1991, its use among older women is not without controversy and there is a lack of uniform guidelines. Understanding the factors associated with mammography among older women, therefore, is important from a clinical and policy perspective. This dissertation used a comprehensive array of demographic, socioeconomic, and health-related variables to examine mammography among Medicare beneficiaries in the Asset and Health Dynamics Among the Oldest Old study. Progressive model building using multivariable logistic and multinomial regression was performed and several sensitivity analyses were conducted. The research objectives included: to determine the prevalence of mammography based on self-reports and claims information, assess the concordance between self-reported mammography and Medicare claims, identify the characteristics associated with concordance, and determine the risk factors associated with mammography among older women. The prevalence of self-reported mammography (54%) was twice the prevalence of mammography identified from Medicare claims data (27%). The concordance between self-reported and claims-based mammography use was poor; African Americans and women on Medicaid had significantly lower odds of concordance, primarily due to overreporting. Based on claims data, continuity of care was the factor most strongly associated with mammography use and this finding was extensively explored. Women with at least a high school education, with 2 or more children, and women who participated in regular vigorous activity also were more likely to have had a mammogram. The odds of receiving screening mammography decreased with a woman's age and were lower for women with a decline in self-rated health. Although income and wealth were not independently associated with mammography use, self-expectations about future financial position were. The study of mammography among older women will continue to be an essential research agenda because of increases in life expectancy and health-related quality of life improvements, advances in imaging and therapies, controversy regarding the efficacy and cost-effectiveness of mammography, and Medicare policies to subsidize these services.
Keywords: Health Conditions and Status; Healthcare

Managed Care and the Near-Elderly: Effects of plan enrollment on functionality - Xiao Xu; Gail A Jensen (Applied Economics, 2007)
This paper examines the effects of enrollment in a health maintenance organization (HMO) or a preferred provider organization (PPO) on the functional status of near-elderly adults (aged 55-64), compared to traditional fee-for-service (FFS) plans. A sample of 1306 near-elderly adults with employer-sponsored health insurance are drawn from the 2000-2002 waves of the Health and Retirement Study, a nationally representative panel survey of community-dwelling adults. Regression models are estimated to assess the effects of different types of insurance plans on functionality, as measured by whether or not the individual has any functional limitations. The potential influence of selection bias into alternative types of plans is addressed by limiting the sample to near-elders without a choice of health plans. The effects of HMOs on functionality are shown to be comparable to those of FFS plans among the general near-elderly population. However, significant adverse effects of HMO enrollment on functional status are observed among near-elders with chronic conditions. PPO enrollees have similar functional outcome to FFS enrollees, even among those with chronic conditions. The observed differences in functional outcome across plans have important implications for the practicality of managed care plans serving older adults.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance

Measuring Dissaving Out of Retirement Wealth - Love, David A.; Paul A Smith (Social Science Research Network, 2007)
The approaching retirement of the baby boomers, accelerating trend from DB to DC pension plans, and growing uncertainty over the solvency of Social Security all raise important questions about the ability of households to finance their retirement years with liquid assets, rather than annuities. We use data from four waves of the HRS to investigate how households spend down their retirement wealth, and, in particular, whether they appear to run down their retirement accounts too quickly. We find no evidence of excessive dissaving over the period 1998 to 2004. Indeed, the annuitized value of total wealth rose for most households over this period, suggesting that households are not running down their assets too fast, given their remaining life expectancies.
Keywords: Consumption and Savings; Health Conditions and Status; Net Worth and Assets

Mechanisms of Structural Models: The Case of the Mickey Mantle Effect - Fang, Hanming; Keane, Michael P.; Ahmed Khwaja; Salm, Martin; Daniel S. Silverman (American Economic Review, Papers and Proceedings, 2007)
Keywords: Health Conditions and Status; Medicare/Medicaid/Health Insurance

Modifiable factors for disability: Is there potential for reducing racial disparities in disability in older age? - Mihaela A. Popa (Aging Studies, 2007)
White-Black disparities in disability in the older population are consistently reported in the literature, and are usually ascribed to differences in socio-economic, health, and cognitive status. However, the role of modifiable influences on disability, such as health and lifestyle behaviors or health care utilization on these differences is less clear. This dissertation examines: (1) longitudinal White-Black differences in disability and the potential contributions of distinct health behaviors to these differences; (2) White-Black differences in the effects of health care utilization on trajectories of disability; and (3) whether cognition mediates the effects of health behaviors on disability in Whites and in Blacks, independent of established confounders for these relationships. This dissertation uses longitudinal data from the Asset and Health Dynamics among the Oldest Old study (AHEAD). Trajectories of disability in basic (ADL) and instrumental (IADL) activities of daily living are fit using mixed effects models with time-varying predictors. The mediation effect is tested using a multilevel mediation model. Results indicate that health behaviors close the residual White-Black gap in IADL trajectories but not the residual gap in ADL trajectories. Physical activity participation and maintenance of a normal weight or overweight status resulted in lower ADL and IADL disability levels over time among Whites. None of the health behaviors influenced longitudinal trajectories of disability in Blacks. Short-stay nursing home and home health care utilization was associated with lower ADL and IADL disability levels over time among Blacks. Cognition mediated the effect of physical activity participation on ADL and cognitive IADL in Whites but not in Blacks. That is, physical activity participation had positive effects on ADL and IADL disability both directly, and indirectly through beneficial effects on cognition. Modifiable influences on disability, such as health and lifestyle behaviors and health care utilization should be targeted by intervention programs and regulatory policies in order to narrow or eliminate the White-Black disability disparities. Such interventions may represent effective avenues for achieving the goals of Healthy People 2010 .
Keywords: Demographics; Disabilities; Health Conditions and Status; Healthcare

A Multistage Model for Analyzing Repeated Observations on Depression in Elderly - M. Ataharul Islam; Rafiqul I Chowdhury; Huda, Shahariar (2007)
The problem of depression in elderly, in terms of short and long-term health and economic consequence, needs to be assessed more critically. This study uses the longitudinal data from the six waves of the Health and Retirement Survey to examine the transition to depression, reverse transition from depression to no depression and also repeated transition from no depression to depression after experiencing a reverse transition during a study period. Covariate-dependent Markov models are proposed using the logistic link function based on the Chapman-Kolmogorov equation. A simplified and more flexible approach of constructing the likelihood function is demonstrated in this paper to deal with the branching of a number of transition types starting from a group of subjects with no depression at the beginning of the study.
Keywords: Demographics; Health Conditions and Status

Obesity: The role of economic incentives in individuals' bodyweight choice - Abdus, Salam (University of Minnesota, 2007)
This dissertation investigates the economics of obesity, in particular, the role of economic incentives in individuals' bodyweight choice. In the first essay, it is shown that obesity is negatively correlated with income and health insurance coinsurance rate, using data from the Health and Retirement Study (HRS). In the second essay, I develop and estimate a dynamic structural model of individuals' bodyweight choice. In this model, individuals invest in reducing bodyweight to increase productivity, reduce the probability of death and to reduce health care costs. The dynamics of bodyweight is captured by using the energy balance equation of human body, that is, the calculus of calorie intake, calorie expenditure and bodyweight change. The parameters of the model are estimated using nationally representative data sets (HRS, NHIS, NHANES, Build Study). The model can explain the observed heterogeneity in bodyweight and obesity across individuals and over individuals' lifetimes fairly well, based on the differences in opportunity costs of obesity. Individuals with higher income earning capability tend to be less obese because they have higher opportunity costs of sick days, disability and mortality. Similarly, individuals facing a higher price of health care (i.e. high coinsurance rate) are less likely to be obese. The estimates of the policy-invariant parameters of the model give us the opportunity of conducting some policy experiments. First, raising the coinsurance rate to 1 for all individuals reduces the male prevalence of obesity by 7 . However, raising the coinsurance rate to 1 only for the obese individuals (and keeping the coinsurance rate same as before for non-obese people) leads to a large decrease in the prevalence of obesity (40 ). In this case, individuals have an added incentive to reduce obesity, that is, to reduce the price per unit of health care use.
Keywords: Health Conditions and Status

Redefining Retirement: How Will Boomers Fare? - Brigitte C. Madrian; Olivia S. Mitchell; Beth J Soldo (Oxford University Press, 2007)
Keywords: Consumption and Savings; Health Conditions and Status; Income; Medicare/Medicaid/Health Insurance; Net Worth and Assets; Pensions

The Relationship Between Self-Rated Health and Mortality in Older Black and White Americans - Sei J. Lee; Sandra Y. Moody-Ayers; C. Seth Landefeld; Louise C Walter; Lindquist, Karla; Mark Segal; Kenneth E Covinsky (Journal of the American Geriatrics Society, 2007)
PURPOSE: To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship. METHODS: Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older. Subjects were asked to self-identify their race and their overall health by answering the question, Would you say your health is excellent, very good, good, fair, or poor? Death was determined according to the National Death Index. RESULTS: SRH is a much stronger predictor of mortality in whites than blacks (c -statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95 confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95 CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH. CONCLUSIONS: This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects.
Keywords: Demographics; Health Conditions and Status; Women and Minorities

Risk Tolerance and Alcohol Demand among Adults and Older Adults - Dhaval, Dave; Saffer, Henry (NBER Working Paper, 2007)
This study has two primary goals. These are the examination of the effect of risk tolerance on individuals' demand for alcohol and second, the examination of the demand for alcohol by older adults over the age of 55. The data sets employed are multiple waves from the Panel Study of Income Dynamics (PSID) and the Health and Retirement Study (HRS). While risk tolerance can impact the level of alcohol consumption, it may also affect the sensitivity of demand to prices. There are parallels between the economist's and the psychologist's concept of risk tolerance. Research on attitudes towards risk by psychologists is part of a larger theoretical and empirical literature on personality traits. Psychologists have found risk tolerance to be an important determinant of alcohol consumption. The empirical results indicate that risk aversion has a significant negative effect on alcohol consumption, with the prevalence and consumption among risk-tolerant individuals being six to eight percent higher. Furthermore, the tax elasticity is similar across both risk-averse and risk-tolerant individuals. This suggests that tax policies may be effective in deterring alcohol consumption even among those who have a higher propensity for alcohol use. The significance of research on alcohol demand by individuals ages 55 and older is highlighted by the increased potential for alcohol-related adverse consequences among this demographic group. Comparing younger adults (ages 21-54) with older adults, responses to taxes and prices are higher among the older sub-population. The tax elasticity is estimated at -0.05 for younger adults, compared to -0.20 for older adults.
Keywords: Health Conditions and Status; Risk Taking

Safe Alcohol Limits Similar for Younger and Older Adults - Wellbery, Caroline (American Family Physician, 2007)
The study used data from the U.S. Health and Retirement Study (HRS) and the English Longitudinal Study of Aging (ELSA). For those drinking more than one to two drinks per day, the odds ratios (ORs) in the pooled analysis were 0.96 for reported difficulty with ADLs, 0.75 for reported difficulty with IADLs, and 0.82 for poor cognitive function.
Keywords: Cross-National; Health Conditions and Status

Social Predictors of Driving Cessation Among Older Adults: Understanding the driving continuum - Murtha, Jenai (University of Massachusetts, Boston, 2007)
The purpose of this study was to understand the critical factors, both independently and jointly defined, that condition driving behavior among older persons. The sample was comprised of 6,623 respondents 70+, who completed driving questions for two waves of the Health and Retirement Study. The primary goal was to determine whether social engagement variables, both social involvements and obligations and access to alternative drivers, influence driving behavior. Results provide support showing that social involvements and obligations variables increase the likelihood of driving continuation, and that access to alternative drivers variables increase the likelihood of driving cessation.
Keywords: Health Conditions and Status

Sociodemographic and Health-Related Risks for Loneliness and Outcome Differences - Laurie A. Theeke (Nursing, 2007)
Background. Loneliness is a prevalent problem for older adults and has been shown to be associated with negative physical, psychological, and social variables. There has been limited research focusing on the relationship of loneliness to health. There is a gap in the literature when it comes to understanding how the problem of loneliness relates to the health of older adults in the United States. Purpose. The purpose of this study was to address this gap in the literature through the testing of two models, the first model represented the postulated risks for loneliness and the second model represented the postulated outcomes for those who experience loneliness. Variables were chosen for inclusion in the models based on a review of pertinent quantitative and qualitative literature. Methods. The models were tested using a representative sample of U.S. older adults. Data analysis was performed using data from the 2002 and 2004 waves of the Health and Retirement Study. The sample was limited to respondents aged 50 and older who participated in wave 6 (2002) and wave 7 (2004) without proxy, answered the lonely question at both waves, were community-dwelling in 2002 and who had complete data on selected variables in the model. Univariate and bivariate analyses were followed by logistic regression analysis to identify risks. One-way ANOVAs, comparative means testing and independent analysis of covariance tests were used to evaluate the difference in outcomes for those who were never lonely, briefly lonely, or chronically lonely. Results. Non-married status was consistently the primary predictor of self-report of loneliness, followed by poorer self-report of health status, lower educational level, functional impairment, increasing number of chronic illnesses, younger age, lower income, and less people living in the household. Gender and use of home care were not significant predictors of loneliness. Those who were chronically lonely reported less exercise, more tobacco use, less alcohol use, a greater increase in number of chronic illnesses, higher depression scores, more physician contacts and greater average number of nights in a nursing home than those who were never lonely or briefly lonely. After controlling for significant covariates of loneliness, those who were chronically lonely did not have significantly more physician contacts. Discussion. Loneliness is a prevalent problem for older adults in the United States with its own unique health-related risks and outcomes. Given the prevalence, it should be considered a healthcare priority in the United States. Based on the results of this study, inclusion of loneliness and loneliness risk screening as part of routine health histories for those aged 50 and over should be considered. Future research needs to focus on evaluating the effectiveness of both prevention and treatment interventions for loneliness to provide empirical data to guide evidenced based practice.
Keywords: Demographics; Health Conditions and Status

Some Chronically Ill Adults Wait for Medicare to Arrive - Gina Kolata (New York Times, 2007)
"When uninsured adults with common chronic illnesses became eligible for Medicare, they saw doctors and were hospitalized more often and reported greater medical expenses than people who had had insurance." This article references results of a reseach study led by Dr. John Z. Ananian, published in the New England Journal of Medicine, that used data from the Health and Retirement Study. "Dr. Ayanian and his colleagues focused on 5,158 [of 9,760 adults aged 51 to 61 in 1992] ... who survived to age 65 by 2004 and who either had private insurance or no insurance at all before receiving Medicare."
Keywords: Health Conditions and Status; Medicare/Medicaid/Health Insurance; Retirement Planning and Satisfaction

Subjective Survival Probabilities in the Health and Retirement Study: Systematic Biases and Predictive Validity - Todd E. Elder (Michigan Retirement Research Center Research Paper, 2007)
Recent research has demonstrated that retirement planning and well-being are closely tied to probabilistic forecasts about future events. Using longitudinal data from the Health and Retirement Study, I show that individuals subjective survival forecasts exhibit systematic biases relative to life table data. In particular, many respondents fail to account for increases in yearly mortality rates with age, both longitudinally and in crosssection. Additionally, successive cohorts of the near elderly do not appear to revise survival forecasts to match increases in longevity. Forecasting bias may merely be due to the framing of questions designed to elicit expectations, but real biases may result in suboptimal savings rates and timing of retirement. Cross-sectional variation in subjective survival forecasts also appears to reflect differences in cognitive ability across respondents, suggesting that subjective information is more relevant for some individuals than others. Despite these shortcomings, subjective mortality probabilities predict actual mortality and portfolio choice, and they contain information not found in selfreported health status or objective measures of health limitations.
Keywords: Expectations; Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction

Three Essays on Health Insurance and Health Care Consumption - Liu, Fei (Indiana University, 2007)
The first essay of this dissertation aims to study the decision to enroll in supplementary insurance plans for the Medicare elderly. It also examines the impact of insurance status on several health care utilization measures. The insurance decision and utilization can be influenced by common unobserved attributes, such as attitude toward risks. Therefore, I model medical utilization and insurance choices jointly with a latent factor specification in order to control for unobserved heterogeneity. The estimation method is maximum simulated likelihood. This chapter analyzes a five-wave panel data set derived from the Health and Retirement Study. The empirical results indicate a significant positive relation between supplementary insurance and nights spent in a nursing home, nursing home admission frequency, and hospital admission frequency. The evidence of selection on unobservables is modest. The results also show that supplementary insurance has a negative impact on number of doctor visits in clinics, a measure which excludes doctor contacts made in a hospital or nursing home. In addition, the number of doctor visits exhibits high positive correlation with unobserved heterogeneity. The second essay studies the impact of various supplementary insurance plans on medical expenditures of the Medicare elderly, with a focus on total out-of-pocket expenditure on all kinds of medical services used and out-of-pocket expenditure on prescription drugs. I use quantile regression method and finite mixture models to account for heterogeneity in medical consumption. The empirical results demonstrate the distinct impact of different supplementary insurance plans on health care expenditures. Employer-sponsored supplementary plans have a significant negative impact on total out-of-pocket, and out-of-pocket drug expenditure, relative to individually purchased plans; HMO plans decrease out-of-pocket expenditure significantly relative to other private plans. Quantile regressions show mild variation in the impact of supplementary insurance choices across quantiles. The results from finite mixture models support the hypothesis which assumes the existence of two latent subpopulations. That is, the impact of insurance choice is quite different in the heavy users group and the light users group. The third essay investigates the switching behavior of non-elderly enrollees in U.S. managed care plans. Treatment effect analysis is used to examine the disaggregated expenditures of plan switchers and plan stayers prior to their decision to switch or stay. Propensity score matching methods are used to estimate the average treatment effects on the treated. The results, which are based on a national representative data set from the Medical Expenditure Panel Survey, indicate that switchers (from HMO to non-HMO) spend more on hospitalization. The other type of switchers (from non-HMO to HMO) spends less on prescribed medicine and office-based physician visits. The findings suggest that the non-HMO private managed care plans provide better coverage on hospitalization, office-based physician visits and prescribed medicine than the HMO plans.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Methodology

Veteran Status, Health Status, and Use of Health Services - Paul R Brezinski (University of Iowa, 2007)
There are more than seven million veterans aged 70 and older in the United States. Prior research indicates differences in health status and health resource utilization of older veterans, compared with nonveterans of the same age cohort. Improved understanding of these differences can inform fiscal and social policy. One important contributing factor to these differences is the impact of the G.I. Bill. Education is strongly associated with improved health status. Results have implications for health care and education policy, as well as for retirement benefits. This longitudinal research evaluates hypotheses regarding veterans' health status, physician use, and hospital use compared to nonveterans. Education is expected to mediate the veteran effects. The study draws on the Andersen Behavioral Model (1995) for its conceptual framework and is among the most comprehensive applications of the predisposing, enabling, and need paradigm to date. Six waves (1993-2004) of the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD) are analyzed. Primary analyses were conducted using a dichotomous veteran variable (veteran/nonveteran). Separate veteran subgroup analyses (early/late entry, disabled/not disabled, career/noncareer) were also conducted. The study finds evidence of a positive effect of veteran status on both health status and physician utilization, but not hospital utilization. Compared to nonveterans, early entry veterans, non-career veterans and non-disabled veterans have higher health status. Late entry veterans, non-career veterans, and disabled veterans use more physician services relative to nonveterans. The study finds a strong positive effect of education on both health status and physician utilization. Education mediates the veteran status effect on health status and has a direct effect on physician utilization for both veterans and nonveterans. Veteran status also has effects on physician utilization that can not be attributed to education. Further research is warranted to discover specific effects among other veteran cohorts that could be applied to reshape the Veterans' Health Administration and the Military Health delivery systems, as well as to Medicare benefits.
Keywords: Health Conditions and Status; Healthcare

What Level of Alcohol Consumption Is Hazardous for Older People? Functioning and Mortality in U.S. and English National Cohorts - Iain A Lang; Jack M. Guralnik; Robert B Wallace; David Meltzer (Journal of the American Geriatrics Society, 2007)
OBJECTIVES: To estimate disability plus mortality risks in older people according to level of alcohol intake. DESIGN: Two population-based cohort studies. SETTING: The Health and Retirement Study (United States) and the English Longitudinal Study of Aging (England). PARTICIPANTS: Thirteen thousand three hundred thirtythree individuals aged 65 and older followed for 4 to 5 years. MEASUREMENTS: Difficulties with activities of daily living (ADLs), instrumental activities of daily living (IADLs), poor cognitive function, and mortality. RESULTS: One-tenth (10.8 ) of U.S. men, 28.6 of English men, 2.9 of U.S. women, and 10.3 of English women drank more than the U.S. National Institute on Alcohol Abuse and Alcoholism recommended limit for people aged 65 and older. Odds ratios (ORs) of disability, or disability plus mortality, in subjects drinking an average of more than one to two drinks per day were similar to ORs in subjects drinking an average of more than none to one drink per day. For example, those drinking more than one to two drinks per day at baseline had an OR of 1.0 (95 confidence interval (CI)50.8 1.2) for ADL problems, 0.7 (95 CI50.6 1.0) for IADL problems, and 0.8 (95 CI5 0.6 1.1) for poor cognitive function. Findings were robust across alternative models. The shape of the relationship between alcohol consumption and risk of disability was similar in men and women. CONCLUSION: Functioning and mortality outcomes in older people with alcohol intakes above U.S. recommended levels for the old but within recommendations for younger adults are not poor. More empirical evidence of net benefit is needed to support screening and intervention efforts in community-living older people with no specific contraindications who drink more than one to two drinks per day.
Keywords: Cross-National; Health Conditions and Status; Methodology

Women of the 1950s and the Normative Life Course: The implications of childlessness, fertility timing, and marital status for Psychological well-being in late midlife. - Koropeckyj-Cox, Tanya; Pienta, Amy M.; Tyson H Brown (International Journal of Aging and Human Development, 2007)
We explore women's psychological well-being in late midlife in relation to childlessness and timing of entry into motherhood. Using two U.S. surveys, Health and Retirement Study (HRS) (1992) and National Survey of Families and Households (NSFH) (Sweet, Bumpass, and Call, 1988), we assess the well-being of childless women in their 50s compared to mothers with early, delayed, or normatively timed first births. We focus on the cohorts born between 1928 and 1941, who experienced strong normative pressures during the baby boom with regard to marriage and child-bearing. We find few differences among childless women but lower well-being among early mothers, related to singlehood and poorer socioeconomic status. Unmarried mothers are significantly disadvantaged regardless of maternal timing, controlling for socioeconomic status. Current maternal demands are independently related to well-being and help to explain observed differences in family satisfaction. Overall, childlessness and off-time child-bearing are related to midlife well-being through their link with more proximate factors, particularly current marital status, health, and socioeconomic status.
Keywords: Adult children; Demographics; Event History/Life Cycle; Health Conditions and Status; Women and Minorities

Analysis of poststroke sleep abnormality from health and retirement study survey, 2002 - Afshin A Divani; Amardeep Hoonjan; Jarrett Hesselbirg; Luboslav Halik; Siatta Dunbar; Sana Khan (Stroke, 2006)
Keywords: Health Conditions and Status

Bridging the Gaps: The effects of level and duration of care, grandchild characteristics and parental involvement on depressive symptoms among grandparents raising grandchildren - Lindsey A Baker (University of Massachusetts, Boston, 2006)
Using the Health and Retirement Study, this research examines well-being among grandparents raising grandchildren during middle to late life, specifically looking at depressive symptoms. For the first time, waves 2000 and 2002 of the HRS not only allow researchers to identify grandparents raising grandchildren in the dataset, but also provide information on the grandchild(ren) being raised and the adult child (of the grandparent) who is the parent of those children. A series of logistic regressions are run to determine the impact of several factors on depression among the study respondents. Study results indicate that while grandparents raising grandchildren do exhibit higher levels of depression when compared with grandparents providing both moderate and low levels of care to grandchildren, this is explained by the increased risk of depression grandparents raising grandchildren face due to their demographic characteristics and socioeconomic status. However, grandparents who began raising a grandchild between 2000 and 2002 were significantly more likely to become depressed than grandparents who were not raising a grandchild at either wave. Finally, grandparents raising at least one grandson have higher levels of depression than grandparents who are raising only granddaughters. However, this is explained by differences in demographic characteristics, socioeconomic status and health status which place the groups of grandparents raising only granddaughters at increased risk of depression. These findings suggest that grandparents raising grandchildren, particularly those who have recently begun raising a grandchild, are in need of services that can help them deal with the care of that grandchild. These services include not only support groups, which deal directly with the high levels of depression seen in this group, but also programs that help grandparents obtain adequate housing and maintain financial stability, which may help to indirectly improve the psychological well-being of grandparents raising grandchildren.
Keywords: Adult children; Health Conditions and Status

Caring for Depression and Comorbid Pain: Evidence from HRS and HCC - Tian, Haijun (The Pardee RAND Graduate School, 2006)
Depression is a common and serious illness, which often occurs together with painful physical symptoms. Though depression and its social and economical impacts have been well documented in the past decades, the role of pain comorbidity is far less understood. Based on two recent national survey datasets, Health and Retirement Study, and Healthcare for Communities, this dissertation investigates the interaction of depression and pain and its impact on labor market, financial, insurance, disability, medication decision, and medication costs outcomes. Chapter 2 examined the relationship between depression and pain, and labor market, financial, insurance and disability outcomes among Americans aged 55-65, using wave 3 of Health and Retirement Survey. It found that depression and comorbid pain was associated with worse labor market, financial, insurance and disability outcomes compared to depression alone, and showed the adverse effects were attributed disproportionally to individuals with depression and comorbid pain versus "pure" depression. Chapter 3 examined the relationship between depression and pain, and medication behavior and medication costs outcomes in a nationally representative cross-section of Americans, using first wave of Healthcare for Communities survey. It found that depressed individuals with pain comorbidity were substantially less likely to take antidepressant medications compared to those with depression only, and pain comorbidity was associated with a heavier burden on total medication costs and prescription drug costs. Chapter 4 used Health and Retirement Survey to analyze the effect of depression and comorbid pain on the transition from employment to full retirement for male and female workers. It found that depression and comorbid pain predicted early retirement for female workers, but depression alone did not predict fully retirement for either female workers or male workers. This dissertation not only makes an important contribution to our understanding of depression and pain comorbidity in terms of its prevalence in the general population, and its effect on treatment and access to care, it will also inform health policy makers who want to reduce the burden of depression and pain, and has implications for health care providers and practitioners to improve the quality of care for depression and pain comorbidity.
Keywords: Employment and Labor Force; Health Conditions and Status; Healthcare; Public Policy

Change in Depression of Spousal Caregivers of Dementia Patients - Tweedy, Maureen P. (University of North Texas, 2006)
Caring for a family member or loved one with dementia places a heavy burden on those providing the care. Caregivers often develop chronic depression because of having to deal with this burden. A great deal of literature has been published discussing coping effectiveness, effects of social support, and other internal and external means of support for the caregiver. However, little has been written about the changes, if any, in depression that the caregiver experiences after the termination of care, either through institutionalization or death of the person with dementia. This study examined whether there is a change in depression of spousal caregivers after institutionalization of the dementia care recipient as well as any changes in depression that may have occurred as a result of the death of the dementia care recipient. Two theoretical models, the wear and tear model and the adaptation model were discussed in terms of caregiver depression after institutionalization of the dementia care recipient. Two other theoretical models, the relief model and the stress model, were discussed in terms of caregiver depression after the death of the dementia care recipient. Datasets from the National Institute on Aging sponsored Health and Retirement Study were analyzed. Results indicate that both male and female spousal caregivers report an increase in depression after the institutionalization or death of the dementia care recipient, but that as time passes, males report a decrease in depression while females continue to report an increase in depression.
Keywords: Health Conditions and Status; Healthcare

Consumption and Economic Well-Being at Older Ages: Income- and Consumption-Based Poverty Measures in the HRS - Michael D Hurd; Susann Rohwedder (RAND Working Paper, 2006)
According to economic theory, well-being or utility depends on consumption. However, at the household level, total consumption is rarely well measured because its collection requires a great deal of survey time. As a result income has been widely used to assess well-being and poverty rates. Yet, because households can use wealth to consume more than income, so an income-based measure of well-being could yield misleading results for many households. We use data from the Health and Retirement Study to find income-based poverty rates which we compare with poverty rates as measured in the Current Population Survey. We use HRS consumption data to calculate a consumption-based poverty rate and study the relationship between income-based and consumption-based poverty measures. We find that a poverty rate based on consumption is lower than an income-based poverty rate. Particularly noteworthy is the much lower rate among the oldest single persons such as widows. The explanation for the difference is the ability to consume out of wealth.
Keywords: Consumption and Savings; Health Conditions and Status; Income; Methodology

The Demography of Community Based Care: The Late Middle-Aged Versus the Elderly - Julie C Lima (Brown University, 2006)
Keywords: Health Conditions and Status; Healthcare

Depression, activities of daily living, and retirement - Jackson, Lauren Innes (University of North Texas, 2006)
Depression is a common clinical and subclinical psychiatric disorder in the middle-age to older adult population. This study examined the relationship between depression and activities of daily living (ADLs) in middle-age to older adults. This study examined longitudinal data from the 1998, wave 4, and 2000, wave 5, of the Health and Retirement Study (HRS), a National Panel Study sponsored by the National Institute on Aging. A negative cross-sectional and longitudinal relationship between higher ADL scores and depression was hypothesized. A goal of the present study was to determine the temporal precedence of these two constructs using a cross-lag panel design to first examine the cross-sectional relationship between ADLs and depression at time-one and at time-two, and then the time-one to time-two longitudinal relationships to examine temporal precedence possible causal relationships. Finally, differences in these correlational relationships by retirement status and then by marital status were tested. There were several interesting findings, including those who were retired in both 1998 and 2000 reported fewer ADLs (i.e., worse functioning), but also reported better health than those who were working in both 1998 and 2000. Similarly, those people who were not married in both 1998 and 2000 reported fewer ADLs but better health than those who were married in both 1998 and 2000. Married individuals reported fewer depressive symptoms than those who were not married.
Keywords: Health Conditions and Status; Healthcare

Development and Validation of a Prognostic Index for 4-year Mortality in Older Adults - Sei J. Lee; Lindquist, Karla; Mark Segal; Kenneth E Covinsky (Journal of the American Medical Association, 2006)
Context: Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment. . Objective To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report. . Design, Setting, and Participants Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11 701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index. Main Outcome Measure Death by December 31, 2002. Results: The overall response rate was 81 . During the 4-year follow-up, there were 1361 deaths (12 ) in the development cohort and 1072 deaths (13 ) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, 85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index 25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point. Scores on the risk index were strongly associated with 4-year mortality in the validation cohort, with 0 to 5 points predicting a less than 4 risk, 6 to 9 points predicting a 15 risk, 10 to 13 points predicting a 42 risk, and 14 or more points predicting a 64 risk. The risk index showed excellent discrimination with a c statistic of 0.84 in the development cohort and 0.82 in the validation cohort. Conclusion: This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology

Development and validation of an index to predict activity of daily living dependence in community-dwelling elders - Kenneth E Covinsky; Hilton, Joan; Lindquist, Karla; Dudley, R. A. (Medical Care, 2006)
BACKGROUND: Maintaining independence in daily functioning is an important health outcome in older adults. A key measure of functional independence in elders is the ability to do activities of daily living (ADL) without the assistance of another person. However, few prognostic indices have been developed that stratify elders into groups at variable risk for developing ADL dependence. OBJECTIVE: We sought to develop and validate a prognostic index that distinguishes between elders at different risk of ADL dependence. RESEARCH DESIGN, SUBJECTS, AND MEASURES: We studied subjects enrolled in Asset and Health Dynamics Among the Oldest Old (AHEAD), a nationally representative cohort of elders older than the age of 70. We included 5239 subjects (mean age, 77) reporting that they could do each of 5 ADL (bathing, dressing, toileting, transferring, and eating) without the assistance of another person at baseline. Subjects were divided into development (n = 3245) and validation (n = 1994) samples based on region of the United States. Our primary outcome was the need for help (dependence) with at least one ADL at 2 years. We used logistic regression to select among predictor variables encompassing several domains: demographic characteristics, comorbid conditions, functional status, cognitive status, and general health indicators. RESULTS: The 9 independent predictors of 2-year ADL dependence were age older than 80, diabetes, difficulty walking several blocks, difficulty bathing or dressing, need for help with personal finances, difficulty lifting 10 pounds, inability to name the Vice President, history of falling, and low body mass index. We created a risk score by assigning 1 point to each risk factor. In the development sample, rates of 2-year ADL dependence in subjects with 0, 1, 2, 3, 4, and 5 or more risk factors were 1.3 , 2.8 , 3.8 , 10 , 22 , and 33 , respectively (P 0.001, roc area = 0.79). In the validation sample, the rates were 0.7 , 4.3 , 8.7 , 11 , 18 , and 40 (P 0.001, roc area = 0.77). The risk score also discriminated between subjects at variable risk for a combined outcome of either ADL decline or death (4.3 , 7.6 , 15 , 21 , 30 , and 47 ). CONCLUSION: Using data available from patient reports, we validated a simple risk index that distinguished between elders at variable risk of ADL dependence. This index may be useful for identifying elders at high risk of poor outcomes or for risk adjustment.
Keywords: Health Conditions and Status; Healthcare; Risk Taking

Disease and Disadvantage in the United States and in England - James Banks; Michael Marmot; Oldfield, Zoë; James P Smith (Journal of the American Medical Association, 2006)
Context The United States spends considerably more money on health care than the United Kingdom, but whether that translates to better health outcomes is unknown. Objective To assess the relative heath status of older individuals in England and the United States, especially how their health status varies by important indicators of socioeconomic position. Design, Setting, and Participants We analyzed representative samples of residents aged 55 to 64 years from both countries using 2002 data from the US Health and Retirement Survey (n=4386) and the English Longitudinal Study of Aging (n=3681), which were designed to have directly comparable measures of health, income, and education. This analysis is supplemented by samples of those aged 40 to 70 years from the 1999-2002 waves of National Health and Nutrition Examination Survey (n=2097) and the 2003 wave of the Health Survey for England (n=5526). These surveys contain extensive and comparable biological disease markers on respondents, which are used to determine whether differential propensities to report illness can explain these health differences. To ensure that health differences are not solely due to health issues in the black or Latino populations in the United States, the analysis is limited to non-Hispanic whites in both countries. Main Outcome Measure Self-reported prevalence rates of several chronic diseases related to diabetes and heart disease, adjusted for age and health behavior risk factors, were compared between the 2 countries and across education and income classes within each country. Results The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences. These differences between countries or across SES groups within each country are not due to biases in self-reported disease because biological markers of disease exhibit exactly the same patterns. To illustrate, among those aged 55 to 64 years, diabetes prevalence is twice as high in the United States and only one fifth of this difference can be explained by a common set of risk factors. Similarly, among middleaged adults, mean levels of C-reactive protein are 20 higher in the United States compared with England and mean high-density lipoprotein cholesterol levels are 14 lower. These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the United States as well. Conclusion Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the SES distribution.
Keywords: Cross-National; Health Conditions and Status; Methodology

Diverse Pathways in Retirement Transitions: Influences of Family, Work, Wealth, and Health - Peters, Cheryl L. (Oregon State University, 2006)
Shaped by life course and feminist perspectives, this study investigated the influence of finances, human capital, health, family situations, and work factors on two different retirement transitions among married and partnered men and women. Because women and men arrive at retirement under different life circumstances, logistic regression analyses were conducted separately by gender. Respondents were drawn from Waves 1–4 of the biennial, longitudinal Health and Retirement Survey (HRS) and included individuals who retired between Waves 1 and 2 (1992–1994), Waves 2 and 3 (1994–1996), and Waves 3 and 4 (1996–1998). Retirees (n = 1,275) transitioned from the labor force at Time 1 to either a partial or complete retirement at Time 2. Results indicated that, relative to partially retired men, completely retired men had higher earnings at their job, worked for larger companies, were more likely labor union members, were covered in pension plans, started pension incomes at Time 2, had health insurance that continued in retirement, likely covered partners in their health plan, were older, were in poorer health, and had provided 400+ hours of care to a grandchild in the last year. Relative to completely retired men, partially retired men had more wealth, were more likely receiving health insurance coverage from their partners' health plan, had partners who were working for pay at Time 2, had fewer years at their last job, retired earlier than planned, and perceived their last jobs as important. Relative to partially retired women, completely retired women were more likely covered in pension plans, had health insurance that continued in retirement, were more likely labor union members, were White, were older, were in poorer health, and had grandchildren in the home at the time of retirement. Relative to completely retired women, partially retired women had partners who were working for pay at Time 2, retired earlier than planned, and were providing financial support to another individual. Results suggest that partial retirement is a possible solution for workers trying to negotiate a labor force exit while keeping financial and health benefits. Implications and future directions were explored.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction; Women and Minorities

Does Working Longer Make People Healthier and Happier? - Calvo, Esteban (Center for Retirement Research Issue Brief, 2006)
Financing retirement is one of the major challenges facing an aging U.S. population. If individuals continue to retire in their early 60s, many will be hard pressed to maintain an adequate standard of living throughout retirement due to the declining role of Social Security, the shift to 401(k) plans, and low personal saving rates. Combine the retirement income crunch with the dramatic increase in life expectancy, and continued employment in later life appears to be an attractive option. While it is clear that working longer would benefit older Americans financially, less attention has focused on the non-monetary effects of work at older ages. This brief addresses the impact of late-life paid work on physical and psychological well-being. The first section reviews the literature on work at older ages and elderly well-being. The second section describes the analysis. The third and fourth sections present the results. The fifth section identifies vulnerable groups. A final section offers concluding thoughts.
Keywords: Employment and Labor Force; Expectations; Health Conditions and Status; Healthcare

A Dynamic Model of Retirement and Social Security Reform Expectations: A Solution to the New Early Retirement Puzzle - Hugo Benítez-Silva; Debra S. Dwyer; Sanderson, Warren C. (Michigan Retirement Research Center Research Paper, 2006)
The need for Social Security Reform in the next years is hardly a matter of debate. Therefore, the widespread believe among Americans that Social Security will not be able to pay benefits in the long run at the level that was anticipated, does not come as a surprise. The government acknowledges the situation, and predicts that substantial benefits cuts will be necessary, yet no legislation has been passed to tackle the problem. Researchers, however, have rarely modeled the uncertainty over Social Security reform and benefit levels, and how they affect claiming behavior and retirement. The purpose of this paper is to assess the extent to which these perceptions of future cuts might explain the puzzle of earlier take-up despite bigger penalties to doing so in the presence of increasing longevity. By introducing a small amount of uncertainty (based on self-reported responses to questions regarding expectations over future cuts) of a relatively small cut (compared with what the government reports as necessary to solve the crisis) in a dynamic life-cycle model of retirement, we are able to match the claiming behavior observed in the data, without relying on heterogeneous preferences. Our results support the hypothesis that expectations over future benefits are affecting current behavior. We find that a mis-specified dynamic retirement model would erroneously predict that an increase in the NRA would delay claiming behavior and increase labor supply at older ages. Once the appropriate earnings test incentives are modeled, and we account for the probability of reforms to the system, an increase in the NRA has little effect on claiming behavior, and it can even increase the proportion of individuals claiming before the NRA.
Keywords: Expectations; Health Conditions and Status; Public Policy; Retirement Planning and Satisfaction; Social Security

The Effects of Private Pension Types on Older American Workers Portfolio Decisions and the Role of Health Measures in Understanding Expected Longevity - Ni, Huan (State University of New York at Stony Brook, 2006)
Private pensions are regarded as the most important source of retirement income other than Social Security. Previous studies have found significant effects of pensions on individual decisions regarding wealth accumulation, labor supply, and retirement income security. However, few studies have investigated the effects of pension on individuals portfolio choices. Using the Health and Retirement Study (HRS), a panel data set of Older Americans. my study is one of the first to investigate pension effects on older American workers portfolio choices by differentiating Defined-Benefit (DB) pensions from Defined-Contribution (DC) pensions. I first investigate how pension types affect individual stock market participation by performing a two-step procedure. Without differentiating between pension types, pension has been found to have a positive effect on stock investments. My results of both cross-sectional and panel analysis, after correcting for sample selection, and controlling for unobserved heterogeneity, show that compared to holding a DB pension, holding DC pensions not only decreases an individuals probability of participating in the stock market, but also leads to less investments in stocks after stock market entry. Secondly, I test pension type effects on older workers investment decisions in individual retirement accounts (IRAs), over which individuals have full control. Panel analysis shows that individuals with DC pensions are more likely to hold IRAs compared to those who have DBs. I also find that individuals have rather consistent investment patterns within their pension and IRA accounts. In order to better understand how individual expected longevity evolves over time, which can affect Older Americans investment planning horizon, we propose to use the self-reported health change as a direct measure of health flows in empirical models. Our results show that after controlling for both subjective and objective measures of health status and unobserved heterogeneity in reporting, self-reported health changes are a more appropriate measure of health dynamics than those used in earlier studies.
Keywords: Health Conditions and Status; Net Worth and Assets; Pensions