A Three Essay Examination of Life Insurance - Mulholland, Barry S. (Texas Tech University, 2014)
Life insurance is an important risk management and financial tool, both for insurance companies and individual households. This dissertation is a combined study of various factors that may be influencing the life insurance sales process and the factors used by households in their decisions to purchase and maintain ownership of life insurance policies. The first study is an attempt to understand factors that affect the demand for life insurance. Life insurance demand has been experiencing a 50-year decline in the U.S. while there has also been a shift away from permanent life insurance products to term life insurance products. We identify exogenous factors influencing the demand for cash value life insurance and examine their importance in explaining the sharp decline in demand for permanent insurance. We find that demographic and tax code changes do not explain the magnitude of decline. Using data from the 1992 through 2010 Surveys of Consumer Finances, we find a consistent downward trend in life insurance ownership, especially among younger and middle-age households. We find the demand for cash value life insurance is centered on households that are wealthier and more financially sophisticated suggesting these products are being used more for their tax-sheltering properties than as a hedge against the loss of human capital. The second study in this dissertation examines advisor beliefs about life insurance illustration effectiveness and advisor attributes that may influence those beliefs. The life insurance illustration is the primary disclosure document used in the sale of life insurance. When an insurance company designates a life insurance policy form to be marketed with a life insurance illustration during the presentation and sale of a life insurance policy, state regulation dictates the content and structure of the illustration. Using data collected in 2012 through an online survey targeting financial advisors providing life insurance advice, we find that over one-third of survey respondents believe the mandated life insurance illustration is a less than effective consumer education and protection tool. We find the contractual relationships between advisors and insurers and between advisors and consumers significantly impact advisor opinions about life insurance illustrations. We find advisors display overconfidence in their knowledge and understanding of life insurance illustrations and this overconfidence appears to impact their opinions about illustrations. We find no significant evidence that the method by which advisors are compensated impacts their opinions about life insurance illustrations. In the third study, we examine life insurance policy lapsation to understand the impact of various factors on the decision to voluntarily lapse a policy. We introduce and test individual cognitive ability variables in a model of the life insurance voluntary lapse decision by individual policyholders using data from the 2008 and 2010 waves of the Health and Retirement Study. We find that one measure of cognitive ability, numeracy, is related to the voluntary lapse decision. While controlling for numeracy, we find evidence supporting the emergency fund hypothesis, finding that those individuals with higher levels of net worth are less likely to voluntarily lapse a policy. We introduce a new measure of shock, kids moving home, and find it has a strong positive relation with the decision to voluntarily lapse a policy. Consistent with life insurance demand theory, we find that those who have recently entered retirement are reducing their life insurance holding.
Keywords: Health Conditions and Status; Insurance; Other; Retirement Planning and Satisfaction

Three Essays in Health, Education, and Retirement - Arons, Robert (University of Rochester, 2014)
In chapter one I examine the impact of Health Maintenance Organization (HMO) coverage on the provision of preventive medicine procedures and undiagnosed disease. Rates of missed preventive care and undiagnosed conditions are substantially lower for middle-aged HMO enrollees compared to non-HMO enrollees. I control for selection with a novel quasi-experiment: turnover in group health insurance contracts at the firm level creates exogenous variation in plan type. The large age heterogeneity in the effect of HMO contracts is consistent with incentive structures in HMOs playing a role in the quality of patient care. In chapter two I use a regression discontinuity framework to analyze the No Child Left Behind (NCLB) Act's attempt to reduce the achievement gap by requiring sociodemographic groups meet group based proficiency count targets. Using a panel of North Carolina public school students in grades three through eight from 2003-2012, I find when a student's group is added to the set of existing accountable groups, it has a small positive impact on subject matter proficiency and test scores. Variation in the application of these laws comes the fact that groups are only held to academic proficiency standards if there are 40 or more tested students in the group within the school. In chapter three I estimate the potential earnings of retirees. Estimating the earnings structure of those no longer working is complex, because (1) health and cognition decline at older ages and drive workers into retirement, (2) retirement may cause changes in health and cognition, and (3) unobserved wage shocks may also drive workers into retirement and bias estimates depending on the direction of selection. Issue (1) is solved by using health and cognitive measures from the data, the Health and Retirement Study. Issues (2)-simultaneity of retirement with health and cognition, and (3)-selection out of the labor force, are controlled for with four instruments, self-reported probability of retirement at age 62 and 65 reported at age 55 and age dummies for 62 and 65. We find that retirees would earn less than a selection corrected estimator would suggest by about $13,000 per year.
Keywords: Adult children; Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction

Three essays on personality and net worth - Nabeshima, George (Kansas State University, 2014)
This dissertation consists of three studies exploring the relationship between personality and wealth related variables. The psychological type theory was used as the theoretical framework for the first two studies, while the doctrine of interactionism was used in the third study. All three studies utilized data from the 2010 panel of the Health and Retirement Study (HRS). The first study examined the relationship between personality traits and net worth. Linear regression results identified the extroversion and conscientiousness traits as being positively associated with net worth. Furthermore, the agreeableness trait was negatively associated with net worth. The second study explored the relationship between personality preference and stock ownership. This study's logistic regression results identified the preference for high openness and high neuroticism as significant and positively associated with stock ownership. A high agreeableness preference was significant and negatively associated with stock ownership. The focus of the third study examined how net worth and income mediated the association between personality and life satisfaction. Regression results from this study identified net worth as being a significant mediating variable in the association between the conscientiousness trait and life satisfaction levels. However, income, in addition to net worth, was also a significant mediating variable when the extroversion and neuroticism traits were used to represent personality trait variables. Results from the three studies identified significant associations between personality traits and components of net worth. These findings contribute to the financial planning field by providing useful information in regards to how mental preferences expressed outwardly though personality traits are related to wealth related variables and life satisfaction. Financial planning practitioners can apply these findings to formulate strategies to assist people grow their wealth levels.
Keywords: Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction

Trajectories of cognitive decline by driving mobility: evidence from the Health and Retirement Study - Moon Choi; Matthew C. Lohman; Briana Mezuk (International journal of geriatric psychiatry, 2014)
OBJECTIVE: The recent emphasis of the importance of aging in place has highlighted the role of transportation in health promotion over the life course. Driving cessation in later life is associated with numerous poor health outcomes including limitations in social and physical functioning and increased risk of mortality. However, little is known about the relationship between driving cessation and change in cognitive functioning in late life. This study examined the association between driving mobility and trajectories of cognitive functioning among older adults.; METHODS: Using data from six waves 1998-2008 of the Health and Retirement Study, trajectories of cognitive functioning were estimated over a 10-year period using longitudinal mixed effects models N=9,135 . Cognitive function was assessed with a modified version of the Telephone Interview for Cognitive Status. Driving status and health characteristics were assessed by self-report.; RESULTS: Older adults who did not drive (former and never drivers) at baseline had lower average cognitive scores compared with active drivers. Former drivers had accelerated cognitive decline over the subsequent 10years compared with active drivers (beta=-0.35, 95 Confidence Interval CI =-0.43 to -0.26) even after controlling for baseline cognitive functioning and health status. The transition to non-driving was associated with a faster cognitive decline among those who were driving at baseline (beta=-0.31, 95 CI=-0.40 to -0.22).; CONCLUSIONS: Older adults without driving mobility had poorer cognitive functioning at baseline and experienced accelerated cognitive decline relative to active drivers over follow-up. Copyright 2013 John Wiley and Sons, Ltd. Copyright 2013 John Wiley and Sons, Ltd.
Keywords: Demographics; Health Conditions and Status; Other

The transition to parent care: Costs, commitments, and caregiver selection among children - Thomas Leopold; Marcel Raab; Henriette Engelhardt (Journal of Marriage and Family, 2014)
This research traced the process of caregiver selection among adult children longitudinally, investigating how transitions to parent care were influenced by previous constellations of caregiving costs and commitments within sibling groups. The authors used data from 6 waves (1998-2008) of the Health and Retirement Study, selecting a sample of families (N=641 parents comprising N=2,452 parent-child dyads) in which they observed at least 1 adult child becoming a caregiver to a previously self-sufficient parent. Among cost-related factors, this transition was predicted primarily by between-sibling differences in previous geographical distances to the parent and, to a lesser extent, competing demands in work and family spheres. The indicators for caregiving commitments showed the importance of reciprocity, path dependency, and parental expectations as motivational forces affecting the process of caregiver selection among adult children. Gender effects revealed the primacy of the mother-daughter tie, as daughters were overrepresented only in transitions to mother care. National Council on Family Relations, 2014.
Keywords: Adult children; Health Conditions and Status; Healthcare; Other

Underwriting mortality risk using cognitive function tests - Hu, Guizhou; Duncan, Ashlee; Bob Brown (Journal of insurance medicine (New York, N.Y.), 2014)
OBJECTIVE: Evaluate the association of selected cognitive function assessments, including two memory tests and two mental status tests, with all-cause mortality. METHOD: Associations between the selected cognitive function tests and mortality were assessed in a longitudinal dataset. The Health and Retirement Study (HRS) includes 27,648 individuals, most of whom were 65 years of age and older; study participants were followed for an average of 8.9 years, and over this interval, 8268 deaths occurred. The association of 4 cognitive function test scores at entry into the study and the observed rates of mortality were evaluated using both a traditional (actuarial) actual vs expected mortality method and a Cox proportional hazard model adjusted for age, gender, smoking, and other covariates. RESULTS: Each cognitive function test was shown to be independently associated with mortality after adjustment for covariates. Further, individual test scores, fit using a continuous model, were shown to be correlated with mortality outcomes. The associations appear to be stronger at a younger age when only age, gender, and smoking were adjusted, but such effect modifications were no longer statistically significant after additional covariates were adjusted. The associations did not appear to be attenuated in a pre-defined healthy subgroup, suggesting that the result could be extrapolated to applicants who would qualify for life insurance. CONCLUSIONS: Cognitive function, as measured by 4 simple screening tests, was shown to be significantly and independently associated with all-cause mortality in a longitudinal dataset of individuals, the majority of whom were 65 years of age and older.
Keywords: Health Conditions and Status

Unsecured Consumer Debt and Mental Health Outcomes in Middle-Aged and Older Americans - Karen A. Zurlo; Yoon, Wonah; Hyungsoo Kim (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2014)
Objectives. Unsecured consumer debt may affect well-being negatively. We evaluated the association between unsecured debt and two distinct outcomes: depressive symptomatology and psychological well-being.Method. Data were obtained from the 2006 Health and Retirement Study. There were 5,817 adults aged 51 who responded to a core survey and psychosocial leave-behind questionnaire. Depressive symptoms were assessed using the revised 8-item Center for Epidemiologic Studies Depression Scale. Psychological well-being was evaluated in a leave-behind questionnaire that had 3 dimensions: self-acceptance, personal growth, and purpose in life.Results. Thirty percent of the respondents had unsecured debt. The magnitude or amount of unsecured debt and the occurrence of unsecured debt were significant predictors of depressive symptoms and lower psychological well-being. Perceived control over personal financial circumstances was a significant predictor of higher psychological well-being.Discussion. In middle-aged and older Americans, unsecured debt has negative effects on mental health because of the associated depressive symptoms and decreased psychological well-being. The deleterious effects of unsecured debt on mental health are largely accounted for by perceived control over personal financial circumstances. Interventions enhancing older adults control over personal financial circumstances may protect against the psychological decrements experienced by those grappling with unsecured debt.
Keywords: Health Conditions and Status; Other

Urinary Incontinence, Depression, and Economic Outcomes in a Cohort of Women Between the Ages of 54 and 65 Years - Hung, Kristin J.; Awtrey, Christopher S.; Tsai, Alexander C. (Obstetrics and Gynecology, 2014)
OBJECTIVE: To estimate the association between urinary incontinence (UI) and probable depression, work disability, and workforce exit. METHODS: The analytic sample consisted of 4,511 women enrolled in the population-based Health and Retirement Study cohort. The analysis baseline was 1996, the year that questions about UI were added to the survey instrument, and at which time study participants were 54 65 years of age. Women were followed-up with biennial interviews until 2010 2011. Outcomes of interest were onset of probable depression, work disability, and workforce exit. Urinary incontinence was specified in different ways based on questions about experience and frequency of urine loss. We fit Cox proportional hazards regression models to the data, adjusting the estimates for baseline sociodemographic and health status variables previously found to confound the association between UI and the outcomes of interest. RESULTS: At baseline, 727 participants (survey-weighted prevalence, 16.6 ; 95 confidence interval CI 15.4 18.0) reported any UI, of which 212 (survey-weighted prevalence, 29.2 ; 95 CI 25.4 33.3) reported urine loss on more than 15 days in the past month; and 1,052 participants were categorized as having probable depression (survey-weighted prevalence, 21.6 ; 95 CI 19.8 23.6). Urinary incontinence was associated with increased risks for probable depression (adjusted hazard ratio, 1.43; 95 CI 1.27 1.62) and work disability (adjusted hazard ratio, 1.21; 95 CI 1.01 1.45), but not workforce exit (adjusted hazard ratio, 1.06; 95 CI 0.93 1.21). CONCLUSION: In a population-based cohort of women between ages 54 and 65 years, UI was associated with increased risks for probable depression and work disability. Improved diagnosis and management of UI may yield significant economic and psychosocial benefits. LEVEL OF EVIDENCE: II
Keywords: Employment and Labor Force; Health Conditions and Status

Veteran Status and Men s Later-Life Cognitive Trajectories: Evidence from the Health and Retirement Study - Maria T. Brown; Janet M Wilmoth; Andrew S London (Journal of Aging and Health, 2014)
Objective: The aim of this study is to determine the extent to which men s later-life cognitive trajectories vary by veteran status. Method: We use Health and Retirement Study (HRS) data to estimate growth curve models examining men s later-life cognitive trajectories by veteran status, war service status, and period of service. Analyses control for early-life characteristics that influence selection into military service and later-life cognition, and mid- to late-life characteristics that potentially mediate the relationship between military service and later-life cognition. Results: Veterans have higher cognition scores relative to nonveterans around retirement age, but their cognition scores decline more rapidly with increasing age, such that cognition scores are similar in both groups among the oldest old. Veterans who served during the Korean War have lower cognition scores around retirement age, but less steep age-related declines, than veterans who served during World War II. Discussion: Findings are discussed in relation to the extant literature, future research, potential service needs, and study limitations.
Keywords: Demographics; Event History/Life Cycle; Health Conditions and Status

Wealth Shocks and Health Outcomes: Evidence from Stock Market Fluctuations - Schwandt, Hannes (Bonn, Germany, Institute for the Study of Labor, 2014)
Do wealth shocks affect the health of the elderly in developed countries? The economic literature is skeptical about such effects which have so far only been found for poor retirees in poor countries. In this paper I show that wealth shocks also matter for the health of wealthy retirees in the US. I exploit the booms and busts in the US stock market as a natural experiment that generated considerable gains and losses in the wealth of stock-holding retirees. Using data from the Health and Retirement Study I construct wealth shocks as the interaction of stock holdings with stock market changes. These constructed wealth shocks are highly predictive of changes in reported wealth. And they strongly affect health outcomes. A 10 wealth shock leads to an improvement of 2-3 of a standard deviation in physical health, mental health and survival rates. Effects are heterogeneous across physical health conditions, with most pronounced effects for the incidence of high blood pressure, smaller effects for heart problems and no effects for arthritis, diabetes, lung diseases and cancer. The comparison with the cross-sectional relationship of wealth and health suggests that the estimated effects of wealth shocks are larger than the long-run wealth elasticity of health. Tables, Figures, Appendixes, References.
Keywords: Health Conditions and Status; Net Worth and Assets

Weight loss in overweight and obese older adults - Sarah E Jackson (Institute of Epidemiology and Health Care, 2014)
The prevalence of obesity has reached dramatic proportions over recent years, and obesity among older adults is becoming an increasingly important concern in developed countries with ageing populations. Weight loss is recommended for all obese individuals, regardless of age, yet while there has been a vast amount of research into factors surrounding weight loss across younger and middle-aged populations, the evidence base on weight loss in older adults is lacking. This thesis uses data from a cross-sectional survey of UK adults, and two large epidemiological studies of ageing, the English Longitudinal Study of Ageing and the Health and Retirement Study in the US, to address this gap in the literature. Study 1 highlights the high prevalence of desire to weigh less and attempts at weight loss among older adults, and Study 2 reveals that a surprisingly high proportion of those who are overweight or obese are achieving clinically meaningful (≥5%) weight loss. Studies 3 and 4 show that despite reductions in cardio-metabolic risk, weight loss in overweight/obese older adults is associated with increased risk of depressed mood, and this association grows stronger with each decade of age. However, Study 5 finds some evidence to suggest that rates of depressed mood might only be increased during the process of weight loss, and that if weight loss is maintained there might be benefits for mood relative to baseline. This research contributes to the understanding of weight loss in older adults – particularly that which occurs in the general population, outside of the trial context – and emphasises the need for health professionals to take into consideration patients' psychological wellbeing when recommending or responding to weight loss at older ages. Limitations of this work and directions for future research are discussed.
Keywords: Cross-National; Demographics; Health Conditions and Status

What Impact Does Old-Age Pension Receipt Have on the Use of Public Assistance Programs Among the Elderly? - Norma B Coe; April Yanyuan Wu (Safety Nets and Benefit Dependence, 2014)
Keywords: Health Conditions and Status; Public Policy; Retirement Planning and Satisfaction; Social Security

Widowhood and depression: new light on gender differences, selection, and psychological adjustment - Sasson, Isaac; Debra Umberson (The journals of gerontology. Series B, Psychological sciences and social sciences, 2014)
Objectives. To document short- and long-term trajectories of depressive symptoms following widowhood and to test whether these trajectories vary by gender and anticipatory spousal loss. Method. Eight waves of prospective panel data from the Health and Retirement Study, over a 14-year period, are used to evaluate gender differences in depressive symptoms following widowhood in late midlife. Short-term trajectories are modeled using a linear regression of change in Center for Epidemiologic Studies Depression (CES-D) score on duration of widowhood. Long-term trajectories are modeled using a mixed-effects hierarchical linear model of CES-D scores over time. We find no gender differences in bereavement effects on depressive symptoms in either short or long term, net of widowhood duration. When spousal death is anticipated, both men and women return to their prewidowhood levels of depressive symptoms within 24 months of becoming widowed. Across marital groups, the continuously married are better off compared with the widowed even prior to spousal loss, whereas early, long-term widowhood is associated with worse outcomes compared with late widowhood. Discussion. Although men and women do not differ in trajectories of depressive symptoms following widowhood, given similar circumstances, women are distinctly disadvantaged in that they are more likely to become widowed and under less favorable conditions.
Keywords: Demographics; Health Conditions and Status; Net Worth and Assets; Other

Aging without Driving: Evidence From the Health and Retirement Study, 1993 to 2008 - Moon Choi; Briana Mezuk (Journal of Applied Gerontology, 2013)
This study characterized older adults who do not drive (former and never drivers) and examined how this group of elders has changed over the past 15 years. Sample included community-living adults aged 70 to 85 who do not drive from the 1993 Asset and Health Dynamics Among the Oldest Old Study (N = 1,979) and 2008 Health and Retirement Study (N = 1,119). Chi-square and t tests were used to assess differences between never and former drivers and between cohorts. Logistic regression was used to examine the predictors of having never driven. The driving status among older adults has improved over the past 15 years as the proportion of never drivers declined from 11 to 2 . However, nondriving has become more concentrated among ethnic minority women, and the gaps in education and net worth between former and never drivers widened over the 15 years.
Keywords: Demographics; Health Conditions and Status; Other; Women and Minorities

Analysis of Cognitive, Functional, Health Service Use, and Cost Trajectories Prior to and Following Memory Loss - Joseph E Gaugler; Hovater, Martha; David L. Roth; Johnston, Joseph A.; Robert L Kane; Sarsour, Khaled (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2013)
Objectives. This brief report examines whether significant changes in cognition, functional dependence, health service use, and out-of-pocket medical expenditures (OOPMD) occur in the years prior to a physician-identified memory problem in a nationally representative sample of older adults. Method. Longitudinal data from the RAND-Health and Retirement Survey were utilized. Those who reported a physician-identified memory problem (n = 387) were compared with a randomly selected control group of similar age, race, and gender who did not indicate a memory problem (n = 387). Multilevel linear models were used to construct trajectories for various measures of cognition, function, health service use, and OOPMD in the years prior to and following memory problem identification. Results. Several trajectories demonstrated significant rates of change in the years leading up to a physician-identified memory problem, including symptoms (mental status, fine motor skills, and instrumental activities of daily living) and utilization (OOPMD and overnight stays in hospital). Discussion. Preclinical declines in mental status and function and increases in hospital use and OOPMD are apparent prior to the formal identification of memory problems. Earlier identification of these changes might provide a basis for interventions that could alter the clinical course of dementia.
Keywords: Health Conditions and Status; Healthcare

Are ongoing cumulative chronic stressors associated with optimism and pessimism in the second half of life? - Yuval Palgi (Anxiety Stress and Coping, 2013)
This study examined the relationship between ongoing cumulative chronic stressors (OCCSs) and optimism and pessimism during the second half of life. The sample comprised of 7166 participants who completed the 2006 Health and Retirement Study's (HRS) psychosocial questionnaire. The association between OCCSs and optimism and pessimism was evaluated among the individuals in the second half of life. The number of OCCSs was associated with both optimism and pessimism. However, the interaction between OCCSs and age was associated with pessimism alone. The relationship between very upsetting OCCSs and pessimism was significant among midlife and young old, but not among old-old participants. A larger number of OCCSs in the second half of life has a deleterious association with optimism and pessimism; however, it may be that the large sample allowed small effects to become significant. Nevertheless, the association between OCCSs and pessimism is regulated by age. Old-old participants maintain a stable level of pessimism, which is not related to the number of very upsetting OCCSs that they reported. Implications of the results are discussed.
Keywords: Demographics; Health Conditions and Status

The Asset and Income Profiles of Residents in Seniors Housing and Care Communities: What Can Be Learned From Existing Data Sets - Norma B Coe; Melissa A. Boyle (Research on Aging, 2013)
The authors use existing, nationally representative surveys to assess the economic characteristics of individuals in three categories of seniors housing and care facilities: independent living communities (ILCs), assisted living residences (ALRs), and continuing care retirement communities (CCRCs). The findings highlight the strengths and weaknesses of using the Health and Retirement Study, National Long-Term Care Survey, and Medicare Current Beneficiary Survey to describe this segment of the population. The results suggest that residents in ILCs and ALRs have lower average incomes than the average costs of these care communities. Conversely, CCRC residents have higher incomes and more assets than those living in private homes, suggesting that CCRCs attract the wealthiest seniors. However, longitudinal analysis is prohibited by the small sample sizes.
Keywords: Health Conditions and Status; Healthcare; Housing; Retirement Planning and Satisfaction

Association between depression and anxiety on blood pressure dysregulation and pulse in the Health and Retirement Study - Christine E Gould; Sherry A. Beaudreau (International journal of geriatric psychiatry, 2013)
OBJECTIVE: Extreme blood pressure (BP) values are associated with symptoms of anxiety and depression, but findings from studies are conflicting. The present study tested linear and curvilinear models of the association between anxiety and depression symptoms and BP in the Health and Retirement Study. The relationship between anxiety and depressive symptoms and pulse was also tested. METHOD: Participants were aged 50 to 104 (N=4179) and completed the Health and Retirement Study Psychosocial Questionnaire and Physical Measurements in 2006. BP and pulse were measured using an automated cuff. The means of three BP and pulse measurements taken 45 to 60s apart were used. Depressive and anxiety symptoms were measured with brief forms of the Center for Epidemiological Studies Depression Scale and Beck Anxiety Inventory. RESULTS: Ordinal regression analyses examined the relationship between BP and anxiety and depressive symptoms. In models adjusted for medical illness and medications, anxiety was associated with systolic hypotension, and depression was associated with diastolic hypotension. Higher pulse was associated with depression but not anxiety. CONCLUSIONS: Findings suggest that BP dysregulation, specifically hypotension, may be a useful indicator of anxiety and depression. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
Keywords: Health Conditions and Status

The association of diabetes complications with physical activity in a representative sample of older adults in the United States - Mary R Janevic; Sara J McLaughlin; Cathleen M. Connell (Chronic illness, 2013)
OBJECTIVE Most adults with diabetes do not engage in the level of physical activity recommended for optimal disease management. Diabetes complications are not generally considered a clinical contraindication to exercise. No prior national studies have examined the associations of these complications with physical activity. METHODS Data are from the 2003 Diabetes Supplement to the nationally representative US Health and Retirement Study (n=1811; age 50 years). Multiple logistic regression was used to examine the association between diabetes complications and the odds of meeting physical activity guidelines. RESULTS Forty-three percent of the sample met physical activity guidelines. Adjusting for sociodemographic variables, retinopathy (odds ratios (OR) OR=0.54, 95 confidence intervals (CI)=0.36-0.81), nephropathy (OR=0.70, 95 CI=0.50-0.99), neuropathy (OR=0.75, 95 CI=0.59-0.95), and heart disease (OR=0.69, 95 CI=0.51-0.94) were all independently associated with reduced odds of meeting guidelines. A borderline significant association was observed for stroke. DISCUSSION Adults with diabetes with complications of the eyes, kidneys, or nerves and those with heart disease are less likely to meet physical activity guidelines compared to those without these complications. These individuals may require additional support from health professionals to achieve recommended amounts of physical activity. More studies are needed to clarify the barriers and benefits to engaging in physical activity in the presence of diabetes complications.
Keywords: Health Conditions and Status

Associations of loneliness in older married men and women - Liat Ayalon; Sharon Shiovitz-Ezra; Yuval Palgi (Aging and Mental Health, 2013)
We evaluated the associations between loneliness and subjective appraisals of marital relationship as well as reciprocal associations of loneliness in married men and women. The Health and Retirement Study is a national survey of older adults over the age of 50, residing in the US. This study is based on a paper and pencil questionnaire administered in the year 2006. Overall, 2723 couples completed this questionnaire. Loneliness was evaluated using the three-item version of the Revised University of California Los Angeles Loneliness Scale. A non-recursive path analysis was conducted. The model suggested that subjective appraisals of the relationship with spouse play a major role in one's sense of loneliness. In addition, loneliness in men and women shares reciprocal associations. The model explained 24 and 29 of the variability in loneliness reported by married men and women, respectively. Results indicate that capitalizing and enhancing one's social life might also be beneficial for his or her partner. Any intervention to alleviate loneliness in married couples has to take into consideration their perceived marital relationship as well as the reciprocal associations of loneliness in married men and women.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare

Biopsychosocial Risk Factors for Driving Cessation: Findings From the Health and Retirement Study - Dugan, Elizabeth; Lee, Chae Man (Journal of Aging and Health, 2013)
Objective: This study aims to identify social, psychological, and biomedical risk factors for current and future driving cessation in older adults. Method: Data from six waves (1998-2008) of the Health and Retirement Study (HRS) were pooled. Participants aged 65 and above were included in the study (N = 17,349). Results: Multivariate logistic regression models to identify risk factors for current and future driving cessation were consistent (age, gender, education, race, marital status, income, cognitive function, limits in activities of daily living and instrumental activities of daily living, vision, health, diabetes, stroke, arthritis, and hip fracture). Only one variable, falls, was associated with future driving cessation (odds ratio OR = 0.92; confidence interval CI = 0.85, 1.0 ), but not current driving cessation. Discussion: Older age, female gender, and minority race were risk factors for current and future cessation. Adults with arthritis were more likely to keep driving compared with those without arthritis.
Keywords: Health Conditions and Status; Risk Taking

THE CARE SPAN Hospice Enrollment Saves Money For Medicare And Improves Care Quality Across A Number Of Different Lengths-Of-Stay - Amy Kelley; Deb, Partha; Qingling Du; Carlson, Melissa D. Aldridge; R Sean Morrison (Health Affairs, 2013)
Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death. Using data from the Health and Retirement Study, 2002-08, and individual Medicare claims, and overcoming limitations of previous work, we found 2,561 in savings to Medicare for each patient enrolled in hospice 53-105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: 2,650, 5,040, and 6,430 per patient enrolled 1-7, 8-14, and 15-30 days prior to death, respectively. Within all periods examined, hospice patients also had significantly lower rates of hospital service use and in-hospital death than matched controls. Instead of attempting to limit Medicare hospice participation, the Centers for Medicare and Medicaid Services should focus on ensuring the timely enrollment of qualified patients who desire the benefit.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance

Causal effects of retirement timing on subjective physical and emotional health - Calvo, Esteban; Sarkisian, Natalia; Tamborini, Christopher R. (The journals of gerontology. Series B, Psychological sciences and social sciences, 2013)
This article explores the effects of the timing of retirement on subjective physical and emotional health. Using panel data from the Health and Retirement Study (HRS), we test 4 theory-based hypotheses about these effects-that retirements maximize health when they happen earlier, later, anytime, or on time. We employ fixed and random effects regression models with instrumental variables to estimate the short- and long-term causal effects of retirement timing on self-reported health and depressive symptoms. Early retirements--those occurring prior to traditional and legal retirement age--dampen health. Workers who begin their retirement transition before cultural and institutional timetables experience the worst health outcomes; this finding offers partial support to the psychosocial-materialist approach that emphasizes the benefits of retiring later. Continued employment after traditionally expected retirement age, however, offers no health benefits. In combination, these findings offer some support for the cultural-institutional approach but suggest that we need to modify our understanding of how cultural-institutional forces operate. Retiring too early can be problematic but no disadvantages are associated with late retirements. Raising the retirement age, therefore, could potentially reduce subjective health of retirees by expanding the group of those whose retirements would be considered early.
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction

Chemo brain --is cancer survivorship related to later-life cognition? Findings from the health and retirement study - Porter, Kristen E. (Journal of Aging and Health, 2013)
OBJECTIVE: Studies have shown a correlation between cancer and cognition referred to as chemo brain. This study investigated the relationship between cancer and later-life cognition using nationally representative data. METHOD: Analysis of the 2006 Health and Retirement Study investigated the (a) effects of cancer survivorship on the total cognition score using linear regression in adults age 65 (n = 9,814) and (b) the effects of cancer treatment on the total recall index using linear regression in adults age 50 (n = 657). RESULTS: Total cognition score is not associated with cancer survivorship. The association between long-term cancer survivorship and cognition score was significant (p .05; b = .276). Total recall index is not associated with chemotherapy. DISCUSSION: These results support other research suggesting that chemo brain may be biased by expectation as well as favored by research that relies upon self-reported cognitive measures versus cognitive testing. The study was limited by the cross-sectional design.
Keywords: Health Conditions and Status; Healthcare

Cognitive and Physical Health of the Older Populations of England, the United States, and Ireland: International Comparability of The Irish Longitudinal Study on Ageing - Savva, George M.; Maty, Siobhan C.; Setti, Annalisa; Feeney, Joanne (Journal of the American Geriatrics Society, 2013)
This article discusses the contribution that international comparisons of the health and well-being of older people make. The comparability of the HRS family of studies that have been modeled on the U.S. Health and Retirement Study (HRS) is discussed. The Irish Longitudinal Study of Ageing (TILDA) is introduced, and the comparability of TILDA data with respect to the HRS family and other studies is described, along with what TILDA will add to international aging research. Data from the 2010 waves of TILDA,HRS and the English Longitudinal Study of Ageing are used to compare the physical and cognitive health of older Irish adults with that of the U.S. and English populations. The study shows that the physical and cognitive health of older people in Ireland is closer to that of their English counterparts than of those in the United States and that similar health inequalities exist in all three countries.
Keywords: Cross-National; ELSA; Health Conditions and Status; Methodology; TILDA

Concordance of Physical Activity Trajectories Among Middle-Aged and Older Married Couples: Impact of Diseases and Functional Difficulties - Li, Kin-Kit; Cardinal, Bradley J.; Acock, Alan C. (The Journals of Gerontology, 2013)
This study examined spousal concordance of physical activity trajectories among middle-aged and older married couples and the influences of recent diseases and functional difficulties on individuals' trajectories and those of their spouses'. Participants included 5,074 married couples aged 50 or older in the Health and Retirement Study in 2004-2010. Participants were categorized into 4 physical activity trajectories (i.e., stable active, adopters, relapsers, and stable sedentary) using confirmatory latent class growth analysis. Individuals' trajectory memberships were predicted by their spouses' memberships, together with recent diseases and functional difficulties of both couple members. In the main, corresponding husbands' trajectories predicted wives' trajectories and vice versa. More functional difficulties predicted higher likelihoods of unfavorable trajectories among individuals but not of their spouses'. Among wives, more recent diseases predicted slightly more physical activity in subsequent data waves but not trajectory memberships. Results supported spousal concordance in physical activity trajectories. The negative impact of functional difficulties was considerably contained within individuals. Increases in physical activity after acquiring diseases among wives were small and short lived. More research is needed to understand the underlying processes, which can be used to improve the design of future physical activity interventions directed toward women, men, and couples.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare

Construct overlap between depression and frailty in later life: evidence from the health and retirement study - Matthew C. Lohman; Briana Mezuk (Comprehensive Psychiatry, 2013)
Background: In epidemiologic research, late-life depression and frailty are often conceptualized and modeled as independent constructs despite having shared risk factors and consequences. Ignoring the interrelationships between depression and frailty may lead to false inferences about the relative importance of these syndromes for morbidity, disability, and mortality. The goal of this study was to use confirmatory latent class analysis to examine the joint relationship between the constructs of depression and frailty among community-dwelling older adults. Method: Data come from the 2008 wave of the Health and Retirement Study, a nationally-representative sample of adults over the age of 50. Analysis is limited to participants 65 and older with complete data on depressive symptoms and frailty indicators (N = 3665). Depressive symptoms were indexed by the 8-item Centers for Epidemiologic Studies Depression (CES-D) scale, and frailty was indexed by modified Fried criteria (i.e., low weight, inactivity, slowness, exhaustion, and weakness). Latent class analysis was used to model the depression and frailty constructs, and latent Kappa coefficients were estimated from competing models to assess the chance-corrected agreement between depression and frailty. Results: Latent class analyses suggested that depression and frailty could best be modeled as distinct syndromes, each with 3 classes. In the joint modeling of depression and frailty latent constructs, 13.0 of participants were classified as high depressive symptoms, 19.0 as mild, and 68.0 as low depressive symptoms. Regarding frailty, 18.2 were classified as severely frail, 18.5 , as mild, and 63.3 with low frailty symptoms. A latent Kappa statistic representing chance-corrected agreement between depression and frailty indicated substantial construct overlap (?l: 0.56, 95 CI: 0.53 0.59). Conclusion: Findings suggest that late-life depression and frailty, as commonly defined in epidemiologic research, are substantially interrelated constructs and identify overlapping populations of older adults. Future research should explicitly examine this relationship to better understand both late-life depression and frailty, and to identify intervention strategies to delay or prevent functional decline in later life.
Keywords: Disabilities; Health Conditions and Status

The continuing significance of discrimination: Multiple forms of discrimination and health - Grollman, Eric Anthony (Indiana University, 2013)
Researchers have documented the continuing significance of discrimination as a key mechanism through which social inequality is produced and maintained. While evidence confirms the consistent, wide-reaching impact of discrimination on health, prior research has yielded mixed findings regarding the extent to which these experiences contribute to health disparities. In this dissertation, I advance a multidimensional conceptualization of discrimination and provide a more comprehensive assessment of the health consequences of these experiences in three ways. First, using data from the Health and Retirement Study (HRS), and the National Survey for Midlife Development in the US (MIDUS), I assess whether the prevalence, distribution, and health consequences of differential treatment vary by question wording ("unfair treatment" versus "discrimination"). I find that the language of "unfair treatment" yields greater reports of differential treatment than do reports of "discrimination." This difference, however, is due to increased reports among privileged social groups, particularly whites. In addition, unfair treatment has a larger negative impact on mental (but not physical) health than discrimination - an effect that is limited to whites. I argue that unfair treatment and discrimination likely reflect distinct concepts, as such cannot be used interchangeably in research. Second, I use MIDUS data to assess the links between multiple disadvantaged statuses, multiple dimensions of discrimination, and health. I find that adults who hold multiple stigmatized statuses are at an elevated risk for poor mental and physical health because they face more forms of discrimination (e.g., race and gender) than their more privileged counterparts. Finally, I use data from the Black Youth Culture Survey to investigate the association between multiple forms of discrimination and sexual health among Black, Latina/o, and white heterosexual youth. I find that youth who face more frequent exposure to multiple forms of discrimination are more likely to engage in risky sexual behaviors: early sexual initiation, multiple sex partners, and inconsistent condom and contraceptive use. These practices, in turn, increase their likelihood of teen pregnancy and having an abortion. Taken together, this dissertation offers ways to better conceptualize and measure discrimination and to assess the broad reach of its consequences for victims' health and well-being.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare; Other; Public Policy

Cross-National Comparisons of Gender Differences in Late-Life Depressive Symptoms in Japan and the United States - Andrew D. Tiedt (The Journals of Gerontology, 2013)
This study compared changes in self-reported depressive symptoms in the United States and Japan across 2 points in time. The investigation focused on the gendered processes of intergenerational coresidence and support as the primary distinctions between nations. Fixed-effects models were fit to examine the covariates of depressive symptoms in the Health and Retirement Study (HRS) and the Nihon University Japanese Longitudinal Study of Aging. Gender differences in depressive symptoms persisted across survey waves in both nations, with Japanese men reporting sharper increases by Time 2 than Japanese women. Getting older was associated with more depressive symptoms among Japanese men, whereas income provided a slight buffering effect. Coresiding with daughters also appeared to protect Japanese men and women with functional limitations from depressive symptoms. HRS data demonstrated that changes in marital status and physical health were correlated with increased depressive symptoms for men and women in the United States. The analyses revealed more variety in Center for Epidemiologic Studies Depression scale reports by gender in Japan than in the United States. Future research should consider the diversity of contemporary Japanese households, reflecting new interpretations of traditional family support relationships.
Keywords: Adult children; Cross-National; Demographics; Health Conditions and Status

Development of a Modified BODE Index as a Mortality Risk Measure Among Older Adults With and Without Chronic Obstructive Pulmonary Disease - Melissa H. Roberts; Douglas W Mapel; Bruse, Shannon; Petersen, Hans; Nyunoya, Toru (American Journal of Epidemiology, 2013)
The BODE index was developed as a prognostic mortality risk tool for persons with chronic obstructive pulmonary disease (COPD). It incorporates 4 measures: body mass index, lung obstruction, dyspnea, and exercise capacity. The intent of this study was to examine how well a BODE-like index constructed using a simpler lung function measure, peak expiratory flow, in combination with physical functioning and symptom information more readily found in survey data (a quasi-BODE index), performs in identifying persons at higher risk of mortality and whether it may be extended as an assessment of mortality risk to persons without diagnosed COPD. Using US national survey data from the Health Retirement Study for 2006 2010, each unit increase in the quasi-BODE index score was associated with a multiplicative 50 increase in mortality risk (odds ratio = 1.50, 95 confidence interval: 1.41, 1.59). The quasi-BODE index is a multidimensional health status instrument based on the BODE index, which is a good predictor of mortality. The quasi-BODE index was compiled using simple measures of physical and respiratory function. It is a potentially useful prognostic instrument for older adult populations with or without COPD, including those with severe physical limitations, particularly when combined with demographic factors and comorbid conditions.
Keywords: Demographics; Health Conditions and Status

Diabetes is associated with cognitive impairment no dementia in the aging, demographics, and memory study (ADAMS) - Christine E Gould; Sherry A. Beaudreau; Salman, Huma (International Psychogeriatrics, 2013)
Individuals with diabetes mellitus have a 1.39 times increased risk of Alzheimer's disease, a 2.38 times increased risk of vascular dementia, and a faster rate of cognitive decline compared to individuals without diabetes (Lu et al., 2009). In a study, over a 9-year follow-up diabetes was associated with accelerated progression from mild cognitive impairment (MCI) to dementia, but was not associated with progression from no impairment to MCI (Xu et al., 2010). Many previous studies on cognitive impairment and diabetes are limited by the use of cognitive screens to diagnose and assess cognitive impairment. A few studies diagnosing cognitive impairment with comprehensive neuropsychological batteries provide mixed results. For instance, Luchinger et al. (2007) found that diabetes was correlated with the presence of MCI, whereas diabetes was not associated with the presence of dementia versus no dementia in the Aging, Demographics, and Memory Study ADAMS; (Llewellyn et al., 2010).
Keywords: Health Conditions and Status; Methodology; Risk Taking

Differences in diabetes mellitus onset for older Black, White, and Mexican Americans - A. R. Quinones; Jersey Liang; Wen Ye (Ethnicity and disease, 2013)
OBJECTIVES: Our research examines the differences in estimated odds of developing diabetes mellitus for White, Black, and Mexican Americans age 51 and over for a period of 11 years. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal data came from 14,783 respondents of the Health and Retirement Study (1995-2006) who reported being diabetes-free at the first time period. Discrete-time survival models were used to analyze ethnic variations in the probability of developing diabetes. MAIN OUTCOME MEASURE: Estimated odds of developing diabetes mellitus. RESULTS: The odds of newly diagnosed diabetes increased between 1995 and 2006, with 11 cumulative incidence for all study participants. The probability of incident diabetes among Black Americans was .01 during the period of 1995/96-1998, which increased to .03 during 1998-2000 and remained at .03 throughout subsequent periods, with cumulative incidence over the 11 years at 12 . In contrast, for Mexican Americans the probability more than doubled from .02 in 1995/ 96-1998 to .05 in 2004-2006, with cumulative incidence at 19 . White Americans had 11 cumulative incidence during the 11 year period. CONCLUSIONS: Relative to White Americans, Mexican Americans had significantly elevated odds of developing diabetes throughout the 11-year period of observation even after controlling for differences in demographic, socioeconomic, and time-varying health characteristics.
Keywords: Health Conditions and Status; Methodology; Women and Minorities

Direct Social Support and Long-term Health Among Middle-Aged and Older Adults With Type 2 Diabetes Mellitus - Emily J Nicklett; Michele M Heisler; Spencer, Michael S.; Ann Marie Rosland (Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 2013)
Objectives. This study examined whether or not direct social support is associated with long-term health among middle-aged and older adults with diabetes mellitus. Method. Direct social support was assessed at baseline (2003) for 1,099 adults with type 2 diabetes mellitus from the Health and Retirement Study. Self-reported health status was examined at baseline and in 4 biennial survey waves (2003-2010). A series of ordinal logistic regression models examined whether or not the 7-item Diabetes Care Profile scale was associated with a subsequent change in health status over time. Additional analyses examined whether or not individual components of direct social support were associated with health status change. Results. After adjusting for baseline covariates, greater direct social support as measured by the Diabetes Care Profile was associated with improved health outcomes over time; however, this trend was not significant (p = .06). The direct social support measures that were associated with improved health over follow-up were support for taking medicines (odds ratio OR = 1.22), physical activity (OR = 1.26), and going to health care providers (OR = 1.22; all p .05). Discussion. Interventions that specifically target improving specific aspects of diabetes social support may be more effective in improving long-term health than less targeted efforts.
Keywords: Adult children; Health Conditions and Status; Other

Disability and Subjective Well-being - Mary C. Daly; Gardiner, Colin S. (Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health, 2013)
The authors examine the relationship between disability, its onset, and subjective well-being in Chapter 15. Individuals with a work-limitating disability self-reported lower levels of life satisfaction. Consistent with previous studies, the authors find a negative relationship between disability status and subjective well-being. Employment status, income, and wealth, mitigates this negative relationship, but disability still emerges as a salient determinant of subjective well-being throughout the analysis.
Keywords: Employment and Labor Force; Expectations; Health Conditions and Status; Healthcare; Income; Retirement Planning and Satisfaction

Disability Shocks Near Retirement Age and Financial Well-Being - Irena Dushi; Rupp, Kalman (Social security bulletin, 2013)
Using Health and Retirement Study data, the authors examine three groups of adults aged 51 56 in 1992 with different disability experiences over the following 8 years. Our analysis reveals three major findings. First, people who started and stayed nondisabled experienced stable financial security, with substantial improvement in household wealth despite substantial labor force withdrawal. Second, people who started as nondisabled but suffered a disability shock experienced a substantial increase in poverty rates and a sharp decline in median incomes. Average earnings loss was the greatest for that group, with public and private benefits replacing less than half of the loss, whereas the reduction in private health insurance coverage was more than alleviated by the increase in public health insurance coverage. Third, people who started and stayed disabled were behind at the baseline and have fallen further behind on most measures. An important exception is substantial improvement in health insurance coverage because of public safety nets.
Keywords: Employment and Labor Force; Health Conditions and Status; Income; Medicare/Medicaid/Health Insurance; Net Worth and Assets; Public Policy; Retirement Planning and Satisfaction

Do wealth disparities contribute to health disparities within racial/ethnic groups? - Craig E Pollack; Cubbin, Catherine; Sania, Ayesha; Mark D Hayward; Donna M. Vallone; Flaherty, Brian; Paula Braveman (Journal of Epidemiology and Community Health, 2013)
Background Though wide disparities in wealth have been documented across racial/ethnic groups, it is largely unknown whether differences in wealth are associated with health disparities within racial/ethnic groups. Methods Data from the Survey of Consumer Finances (2004, ages 25 64) and the Health and Retirement Survey (2004, ages 50 ), containing a wide range of assets and debts variables, were used to calculate net worth (a standard measure of wealth). Among non-Hispanic black, Hispanic and non-Hispanic white populations, we tested whether wealth was associated with self-reported poor/fair health status after accounting for income and education. Results Except among the younger Hispanic population, net worth was significantly associated with poor/fair health status within each racial/ethnic group in both data sets. Adding net worth attenuated the association between education and poor/fair health (in all racial/ethnic groups) and between income and poor/fair health (except among older Hispanics). Conclusions The results add to the literature indicating the importance of including measures of wealth in health research for what they may reveal about disparities not only between but also within different racial/ethnic groups.
Keywords: Demographics; Health Conditions and Status; Net Worth and Assets

Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study - Eileen M. Crimmins; Jessica Faul; Jung K Kim; Heidi M Guyer; Kenneth M. Langa; Mary Beth Ofstedal; Amanda Sonnega; Robert B Wallace; David R Weir (Institute for Social Research, University of Michigan, 2013)
Biomarkers refer to the general range of physiological, metabolic, biochemical, endocrine and genetic measures that can be obtained in living organisms. The term is most commonly used to refer to one-time biochemical or hematological measures made on blood or other available bodily fluids, but perhaps the term should be used for a broader range of measures. In 2006 and 2008, HRS included the following biomarkers measurements, administered in this order: Saliva collection for DNA extraction; Blood spot collection for cholesterol, hemoglobin A1C, CRP and cystatin C analysis (results for C-reactive protein and cystatin C are forthcoming). 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

Does Retirement Induced through Social Security Pension Eligibility Influence Subjective Well-being? A Cross-Country Comparison - Arie Kapteyn; Jinkook Lee; Gema Zamarro (Ann Arbor, MI, University of Michigan Retirement Research Center, 2013)
How does retirement influence subjective well-being? Some studies suggest retirement does not affect subjective well-being or may improve it. Others suggest it adversely affects it. This paper aims at advancing our understanding of the effect of retirement on subjective well-being by (1) using longitudinal data to tease out the retirement effect from age and cohort differences; (2) using instrumental variables to address potential reverse causation of subjective well-being on retirement decisions; and (3) conducting cross-country analyses, exploiting differences in eligibility ages for retirement benefits across countries and within countries. We use panel data from the US Health and Retirement Study and the Survey of Health, Ageing, and Retirement in Europe. This allows us to use a quasi-experimental approach where variations in public pension eligibility due to country and cohort specific retirement ages help identify retirement effects. For both the U.S. and Europe we find that retirement is associated with higher levels of depression. However, when we use instrumental variables we find the opposite result. Retirement induced through Social Security pension eligibility is found to have a positive effect, reducing depression symptoms, although only marginally significant for the U.S. when considering the depression indicator. Retirement is not found to have a significant effect on life satisfaction measures for either the U.S. or Europe.
Keywords: Cross-National; Expectations; Health Conditions and Status; Retirement Planning and Satisfaction; SHARE

Editorial: Dawning of a New Age for Longitudinal Cohort Data - Richard M. Suzman; Harper, Sarah (Journal of Population Ageing, 2013)
Issue Title: Special Issue: Longitudinal Cohort Data
Keywords: Demographics; Health Conditions and Status; Methodology; Other

Education and Dementia Risk: Results From the Aging Demographics and Memory Study - Rashmita Basu (Research on Aging, 2013)
This study examined importance of education on dementia risk among older adults. It explored to what extent this relationship represents an independent effect of education on dementia risk. A cross-sectional sample of adults age 70 years or older was selected from the Aging Demographics and Memory Study, a supplement to the Health and Retirement Study, to examine the association between education and dementia risk and to mitigate the possibility of self-selection bias (unobserved variable bias) in explaining this correlation. An identification strategy using parental and sibling characteristics as instrumental variables for education was used to remove bias from the estimate of education parameter s effect on dementia risk. The association between education and dementia risk was observed after accounting for self-selection bias. Results from the two-stage ordered logit model suggest that the impact of education on dementia risk is not an artifact but rather the observed association between education and dementia incidence has a causal component.
Keywords: Demographics; Health Conditions and Status; Methodology; Risk Taking

Educational Differences in Healthy Behavior Changes and Adherence Among Middle-aged Americans - Rachel Margolis (Journal of health and social behavior, 2013)
Although the better-educated are more likely to practice healthy behaviors when measured at one point in time, there is no clear evidence regarding whether more educated people are more likely to initiate healthy behavior changes in the face of new chronic conditions and whether they are better able to adhere to these healthy changes, once made. I use data from the Health and Retirement Study (HRS) (1992-2010) to examine smoking cessation and starting physical activity by educational attainment over an 18-year period among 16,606 respondents ages 50 to 75. The more-educated are the least likely to smoke and most likely to be physically active in middle age. They are also most likely to make healthy changes overall and better adhere to them. Education also shapes behavior change after a new diagnosis, which likely contributes to socioeconomic status differences in chronic disease management and health outcomes.
Keywords: Demographics; Health Conditions and Status

The effect of social security, health, demography and technology on retirement - Ferreira, Pedro Cavalcanti; dos Santos, Marcelo Rodrigues (Review of Economic Dynamics, 2013)
This article studies the determinants of the labor force participation of the elderly and investigates the factors that may account for the increase in retirement in the second half of the last century. We develop a lifecycle general equilibrium model with endogenous retirement that embeds Social Security legislation and Medicare. Individuals are ex ante heterogeneous with respect to their preferences for leisure and face uncertainty about labor productivity, health status and out-of-pocket medical expenses. The model is calibrated to the U.S. economy in 2000 and is able to reproduce very closely the retirement behavior of the American population. It reproduces the peaks in the distribution of Social Security applications at ages 62 and 65 and the observed facts that low earners and unhealthy individuals retire earlier. It also matches very closely the increase in retirement from 1950 to 2000. Changes in Social Security policy which became much more generous and the introduction of Medicare account for most of the expansion of retirement. In contrast, the isolated impact of the increase in longevity was a delaying of retirement.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Medicare/Medicaid/Health Insurance; Retirement Planning and Satisfaction; Social Security

The Effects of Race, Socioeconomic Status, and Religion on Formal End-of-Life Planning - Burdsall, Tina Dawn Lillian (Portland State University, 2013)
Individuals who are facing death today are doing so in an environment that is significantly different than it was in the past. Medical technology is increasingly able to keep people alive even with multiple complex chronic conditions. While these advances in medicine are beneficial to many, it can also unnecessarily prolong inevitable deaths. Concerns over the ability to have a death that is in alignment with personal values has increased the interest in the use of formal end-of-life planning including writing an advance instructional directive and assigning a durable power of attorney for health care. Although research has indicated that the use of these formal planning strategies is beneficial, not everyone completes them. Using a current nationally representative sample, the three specific aims of this study were to examine whether there are racial and ethnic differences in formal end-of-life planning done by older African American, Hispanic, and White adults; to examine socioeconomic factors including education and income in formal end-of-life planning as well as assess the contribution of these factors in explaining racial and ethnic differences in formal end-of-life planning; and to examine the role of religiosity in formal end-of-life planning and to assess its influence on racial and ethnic differences in explaining formal end-of-life planning. Logistic regression was run on data from the Health and Retirement Study (HRS) in order to analyze the completion of formal end-of-life plans by African American, Hispanic, and White decedents. Exit interviews conducted with knowledgeable proxies in 2008 or 2010 were combined with data from earlier waves of the HRS survey in order to analyze the completion of formal end-of-life plans, race and ethnicity, socioeconomic status, and religion. Both Blacks and Hispanics were less likely to complete a written advance directive, assign a proxy, or complete both forms of formal planning than were Whites. Group differences remained after controlling for region of death and cause of death. Both Blacks and Hispanics were less likely to complete any form of formal planning than Whites. Group differences remained after additionally controlling for gender, age, marital status, whether the decedent had children, income, education, religious preference, importance of religion, and frequency of attending religious services. Higher levels of income and education both increased the odds that formal advance planning would take place. Religious preference was not significant, but decedents who had stated that religion was very important were less likely to plan while those that attended services frequently were more likely to plan. I speculate that the role of cultural capital may partially explain the persistent racial and ethnic disparities and the importance of income and education. Additionally the dominant religious doctrines of Christianity may have a greater influence than the different religious teachings of Protestant and Catholics around end-of-life medical care. Contrary to expected findings, reference groups of those who attend religious services frequently may assist in formal planning. These finding may help guide interventions that can diminish disparities in the end-of-life experience. Understanding who are completing formal plans can help ensure end-of-life care that is in alignment with personal beliefs and values.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Public Policy; Retirement Planning and Satisfaction

Emergency room and inpatient use after cardiac pacemaker implantation - Frank A Sloan; Linda K George; Hu, Linyan (The American journal of cardiology, 2013)
Although studies have demonstrated health benefits, there is limited evidence on utilization and cost changes associated with cardiac pacemaker implantation from national community samples. The aim of this study was to quantify changes in emergency room (ER) and hospital inpatient use and in Medicare payments per beneficiary/year after pacemaker implantation. Outcomes for pacemaker recipients after and before implantation and between pacemaker recipients and controls were compared using propensity score matching. Data came from Health and Retirement Study interviews merged with Medicare claims. Sample subjects were aged 68 years with diagnosed conduction disorders or cardiac dysrhythmias in the previous 3 years. Outcome measures were (1) ER visits, inpatient admissions and days, and Medicare payments for ER and inpatient care in the after period for the pacemaker versus control groups, defined per beneficiary/year, (2) difference in differences in the same 5 outcome variables, and (3) binary variables for whether or not utilization or payments were lower in the after versus before periods for the pacemaker versus control groups. In conclusion, most pacemaker recipients improved, as measured by reductions in use and payments in the after versus before period, and there were reductions in ER visits and hospital admissions for conditions commonly leading to pacemaker implantation.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance

Essays on formal and informal long-term health insurance markets - Woldemichael, Andinet D. (Georgia State University, 2013)
This dissertation consists of two essays examining formal and informal long term health insurance markets. The first essay analyzes heterogeneity of Long-Term Care Insurance policyholders in their lapse decision, and how their ex-ante and ex-post subjective beliefs about the probability of needing Long-Term Care affect their lapse decisions. In this essay, I develop a model of lapse decision in a two-period insurance framework with a Bayesian learning process and implement several empirical specifications of the model using longitudinal data from the Health and Retirement Study. The results show that policyholders' ex-ante point predictions of their probabilities and their uncertainties about them have a persistent but declining impact on lapse decisions. Those who believe that their risk is higher are indeed more likely to remain insured. However, as their uncertainties surrounding their ex-ante point predictions increase, their chances of lapsing increase regardless of their initial perception biases. These results are heterogeneous across cohorts and policyholders and, in particular, show that those in the older group near the average age of Nursing Home entry have a precise prediction of their risk levels compared to the younger cohort. Policy simulations show that a more informed initial purchase decision reduces the chance of lapsing down the road. The second essay examines the extent to which informal risk sharing arrangement provides insurance against health shocks. I develop a comprehensive model of informal risk sharing contract with two-sided limited commitment which extends the standard model to a regime with the following features. Information regarding the nature of realized health shocks is imperfect and individuals' health capital stock serves as a storage technology and is a factor of production. The theoretical results show that, in such a regime, Pareto optimal allocations are history dependent even if participation constraints do not bind. I perform numerical analysis to show that risk sharing against health shock is less likely to be sustainable among non-altruistic individuals with different levels of biological survival rates and health capital productivity. The results also show that optimal allocations vary depending on the set of information available to individuals. Using panel data of households from villages in rural Ethiopia, I test the main predictions of the theoretical model. While there is negative history dependence in transfers among non-altruistic partners, history dependence is positive when risk sharing is along bloodline and kinship. However, neither short-term nor long-term health shocks are insured through informal risk sharing arrangements among non-altruistic individuals.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Methodology; Other

Essays on health economics - Beck, Laurel (The University of Wisconsin - Madison, 2013)
Chapter 1: Medicare provides nearly-universal health insurance for individuals aged 65 and older. The discontinuity in eligibility for Medicare provides an instrument for assessing the effects of insurance coverage on health outcomes. Using regression discontinuity analysis and data from the BRFSS, this paper finds an increase in utilization of preventive health services, as well as an improvement in self-reported health, at age 65. The effects vary across education level and gender. However, these results would be biased by high retirement rates at age 65. To address this issue, I run similar analysis at age 62, when individuals are first eligible to collect Social Security. I find that utilization is positively correlated with insurance but not retirement. The implications of these findings for assessing the cost-effectiveness of preventive care are limited, because the cross-sectional data do not capture the long-term benefits of diagnostic procedures. Chapter 2: This paper assesses the effects of working on the health of less-educated women, particularly mothers. These effects are difficult to estimate because health status affects labor force participation. To address this endogeneity problem, I use an instrumental variables estimation approach. Throughout the 1990s, changes in the EITC and the transition from AFDC to TANF provided exogenous incentives for women to enter the work force, independent of their own health status. This paper builds on the literature by including the incentives created by welfare reform and EITC which vary by state. It also includes measures of both physical and mental self-reported health, giving a broad picture of the effects of entering the labor force on the health of this population. Chapter 3: This chapter (with Atsuko Tanaka), examines the effect of depression on various labor force outcomes, including hours worked and wages. We use panel data from the Japanese Panel Survey of Consumers (JPSC) and the Health and Retirement Study (HRS) to follow respondents over several years, using questions about both mental health and labor force outcomes. In order to understand the causal effect of depression on work participation and compensation, we use deaths of the parents of respondents as an exogenous shock to mental health.
Keywords: Employment and Labor Force; Health Conditions and Status; Insurance; Methodology; Other; Retirement Planning and Satisfaction; Women and Minorities

Essays on Labor Economics - Tanaka, Atsuko (The University of Wisconsin - Madison, 2013)
This dissertation investigates determinants of labor supply decision and worker productivity. In the first two chapters, I investigate inefficiency due to statistical discrimination, in which employers---who do not observe the individual worker's labor force intention---offer a female worker fewer human capital investment opportunities than a male worker because of women's weaker labor force attachment. Owing to imperfect information, productivity inefficiency arises when women receive the same amount of investment despite the fact that women with shorter job tenure are potentially less productive than other workers. To study such a situation, I develop a model of statistical discrimination with a screening mechanism. In the third chapter, a joint project with Laurel Beck, I shift focus from statistical discrimination to worker's mental health as determinants of worker productivity. The first chapter applies the above model empirically to Japanese data, whose features exhibit evidence for statistical discrimination. The Japanese female labor market is found to be in a pooling equilibrium, thereby allowing statistical discrimination. I then estimate the effects of child-care subsides on the degree of statistical discrimination. The counterfactual analysis shows that child-care subsides could bring a drastic change in efficiency to Japan by altering the equilibrium of the worker-firm game from pooling to separating. The second chapter theoretically examines the factors that further complicate the screening process. I argue that long-term wage contracts implicitly distribute compensation from the employed to the unemployed and thus provide workers collective bargaining over wages. This finding allows us a new way to understand long-term contracts. The third chapter examines the effect of depression on various labor force outcomes. We use panel data from the Japanese Panel Survey of Consumers (JPSC) and the Health and Retirement Study (HRS) to follow respondents over several years, using questions about both mental health and labor force outcomes. In order to understand the causal effect of depression on work participation and compensation, we use deaths of the parents or children of respondents as an exogenous shock to mental health, and assess the impact of that event over time.
Keywords: Cross-National; Employment and Labor Force; Health Conditions and Status; Methodology; Net Worth and Assets; Other

Essays on Saving Behavior - Meryl Motika (University of California, Irvine, 2013)
This dissertation combines three projects studying saving behavior. The first chapter presents a model of reference-dependent retirement saving behavior using a gain-loss utility function drawn from prospect theory. I show that this model predicts empirical characteristics of retirement saving behavior including adherence to defaults, under-saving, and the positive correlation between saving rates and financial knowledge. An additional testable implication of the model is that more financially-knowledgeable individuals will have wider variance than people with low financial knowledge. Using data from the Health and Retirement Study, I show that this implication is also supported by empirical results. The second chapter investigates the effects of financial training and planning on saving in a laboratory experiment. Subjects choose when to use tokens to watch video clips over the course of a 50-minute session. Boredom encourages subjects to use tokens immediately, while increased video length in later rounds creates an incentive to use them later. Subjects who receive minimal instructions tend to use their tokens early. Intensive training increases saving rates. The planning treatment has no effect on low-training subjects, but leads intensively trained subjects to smooth tokens across the five rounds rather than spending early or waiting until the end. Evidence from correlations between spending tokens early and high elicited discount rate, as well as subjects' comments about struggling to wait before using tokens, provide support for the external validity of this experiment design. The third chapter examines the relationship between `Big 5' personality traits and low saving rates. Several traits are shown to predict under-saving, with low conscientiousness being particularly important and robust. I then investigate whether personality traits also explain the effects of education, financial literacy, and financial planning. This might occur if certain personality types tended to participate in these activities and also tended to save. I find that the effects of education and financial literacy are robust to personality. The influence of financial planning might be explainable by personality-based selection.
Keywords: Consumption and Savings; Health Conditions and Status; Methodology; Net Worth and Assets

Estimates of the Potential Insurance Value of Disability Insurance for Individuals with Mental Health Impairments - John Bound; Caswell, Kyle J.; Timothy A Waidmann (Ann Arbor, MI, University of Michigan Retirement Research Center, 2013)
Since the mid-1980s there has been dramatic growth in the number and fraction of DI and SSI beneficiaries with mental illness. With longer life expectancies and younger ages of disability onset than beneficiaries with physical impairments, their growth exerts added fiscal pressure on the programs. While not specifically focused on mental illness, fears of an increase in the duration (and thus prevalence) of disability claims that may result from this demographic shift have generated calls to tighten eligibility rules again. Using data from the Health and Retirement Study linked to SSA administrative records, we created statistically matched control groups of non-beneficiaries with severe mental illness. We then estimated the earnings, income, and health insurance coverage among rejected DI/SSI applicants with mental illness who have characteristics comparable to persons awarded benefits on the basis of mental impairments. We found that even after controlling for health and demographic characteristics, DI beneficiaries were substantially worse off than rejected applicants in terms of wealth and income. While these rejected applicants with mental illness were worse off than those with physical impairments, our findings suggests that the programs successfully select applicants with the greatest income needs,and that retrenchment could result in significant hardship.
Keywords: Health Conditions and Status; Public Policy; Social Security

Evidence that Self-Regulatory Mode Affects Retirement Savings - Hyungsoo Kim; Franks, Becca; Higgins, E. Tory (Journal of Aging and Social Policy, 2013)
We examine how self-regulatory motivations of locomotion (initiation) and assessment (evaluation) are related to retirement wealth in middle-aged and older Americans. We test a hypothesis that high locomotion and some assessment levels predict high wealth levels. We use two national data sets: the 2008 Health and Retirement Study (N = 6,464) and the 2005 Midlife in the United States (N = 4,963). We found that a combination of high locomotion and moderate assessment motivation can maximize wealth accumulation. By creating this combination of locomotion and assessment motivations, policy interventions can be more effective in motivating wealth accumulation for retirement, such as a required annual review of retirement savings plans and understandable disclosure of the plans' costs. PUBLICATION ABSTRACT
Keywords: Consumption and Savings; Demographics; Health Conditions and Status; Net Worth and Assets; Public Policy; Retirement Planning and Satisfaction

Factors Predicting the Perception of Positive Aging In the Presence of Chronic Stress - Ray-Mazumder, Shibani (Fielding Graduate University, 2013)
The graying of the Baby Boomer generation brings with it increased longevity, higher prevalence of chronic illness, and changing expectations of the experience of growing old. Some people seem to experience aging better than others even in the face of life stressors. These individuals are defined as being resilient. Within a resilience and empowerment conceptual framework (O'Leary & Bhaju, 2006), the variables of sense of control, social support, loneliness, and optimism are important components that impact the positive aging experience. Using this model, the purpose of this study was to identify predictors of resilience that buffered males and females from chronic stress within the realm of the aging experience. This study was a secondary data analysis on a subsample of 3,262 individuals included in the 2004 core survey of the Health Retirement Study who were asked to complete the Psychosocial Leave-Behind Participant Lifestyle Questionnaire (PLBQ) after their initial interview. A surprising finding was that individuals with low to moderate optimism were more likely to predict their aging as positive even within the presence of chronic stress. In addition, resilient males were more likely to have social support and not be lonely as compared to their non-resilient counterparts. Resilient females were differentiated by non-resilient females by not letting their health get in the way of daily activities and by having a higher sense of control. Findings from this study inform how psychologists must take into account varying factors based on gender that enable individuals to be resilient in their aging experience.
Keywords: Adult children; Demographics; Event History/Life Cycle; Health Conditions and Status

Functional limitations and chronic conditions predict CES-D-8 depression scores - Liu, Ying (California State University, Los Angeles, 2013)
The role of functional limitations and self-reported chronic disease on CES-D-8 depression scores was investigated in the Health and Retirement Study's 2008 data. The sample included 5835 respondent's ranging in age from 50-83. Multivariate adaptive regression splines (MARS) modeling was employed to identify multiple linear splines. Possible predictors included functional limitations (ADL, IADL), chronic diseases (back pain, stroke, arthritis, cancer, high blood pressure, heart disease, lung disease, & diabetes) and demographic measures (age, education, gender, being white, being Hispanic). The MARS modeling process resulted in selection of the following measures in the final model: ADL limitations, IADL limitations, back pain, stroke, education, being female, and being Hispanic. The results indicated that ADL limitations included two splines with a large increase in depression score from zero to one limitation, and a more shallow increase from one to three limitations. IADL limitations included two splines with a linear increase in depression score from zero to two limitations and a decrease in score from two to three limitations. Reporting back pain or stroke resulted in higher depression scores compared to absence of disease. Two splines were identified for education in which the highest depression scores were associated with zero to 7 years of education; there was a linear decline in depression from seven to 17 years of education. Females and Hispanics were associated with higher depression scores compared to males and non-Hispanics. Results emphasize the importance of functional status and selected chronic health conditions on depression scores and provide more detailed descriptions of change than traditional regression-based models.
Keywords: Health Conditions and Status; Healthcare; Methodology; Women and Minorities

Gender-stratified models to examine the relationship between financial hardship and self-reported oral health for older US men and women - Chi, Donald L.; Reginald D. Tucker-Seeley (American journal of public health, 2013)
OBJECTIVES: We evaluated the relationship between financial hardship and self-reported oral health for older men and women. METHODS: We focused on adults in the 2008 Health and Retirement Study (n=1,359). The predictor variables were 4 financial hardship indicators. We used Poisson regression models to estimate the prevalence ratio of poor self-reported oral health. RESULTS: In the non-gender-stratified model, number of financial hardships was not significantly associated with self-reported oral health. Food insecurity was associated with a 12 greater prevalence of poor self-reported oral health (95 confidence interval CI =1.04, 1.21). In the gender-stratified models, women with 3 or more financial hardships had a 24 greater prevalence of poor self-reported oral health than women with zero (95 CI=1.09, 1.40). Number of hardships was not associated with self-reported oral health for men. For men, skipping medications was associated with 50 lower prevalence of poor self-reported oral health (95 CI=0.32, 0.76). CONCLUSIONS: Number of financial hardships was differentially associated with self-reported oral health for older men and women. Most financial hardship indicators affected both genders similarly. Future interventions to improve vulnerable older adults' oral health should account for gender-based heterogeneity in financial hardship experiences.
Keywords: Demographics; Health Conditions and Status; Healthcare; Net Worth and Assets

A Genetic IV Analysis to Assess the Effect of Body Mass Index on Depression in the Health And Retirement Study - Stefan Walter; Mejía-Guevara, Iván; Eric J. Tchetgen Tchetgen; Karestan C Koenen; Ichiro Kawachi; Laura D Kubzansky; M. Maria Glymour (Am J Epidemiol, 2013)
Background: The relationship between adiposity and mental health remains controversial despite extensive prior observational research. We use a genetic risk score (GRS) as an instrumental variable (IV) to estimate effects of increases in body mass index (BMI) on depressive symptoms. Methods: Data are from 11842 (whites = 10322, blacks = 1520) individuals from the nationally representative Health and Retirement Study with data on a 10-item Center for Epidemiologic Studies Depression (CESD) scale and genetics collected in 2006 or 2008. Based on 32 Single Nucleotide Polymorphisms (SNPs) known to predict BMI, we calculated a GRS as the sum of the number of risk alleles multiplied by the per allele effect size on BMI (based on prior publica- tions). We conducted over-identification tests with 4 IVs using subsets of the SNPs organized based on biological pathways (adiposity, appetite, and cardio-pulmonary factors) by which the genes might influence adiposity. Self-reported BMI prior to the assessment of CESD was used for validation of the external instrument. The CESD score was regressed on each genetic IV plus population stratification eigenvectors to derive the IV effect estimate. We compared these to conventional effect estimates derived from regressing CESD on self-reported BMI. Results: The GRS significantly predicted BMI in blacks (r2=0.016, p 0.001) and whites (r2=0.010, p 0.001). Self-reported BMI significantly predicted CESD, more strongly in whites (0.043, 95 -CI: 0.036, 0.05) than blacks (0.021, CI: 0.004, 0.038). IV effect estimates were large and statistically significant for whites (0.0 96, CI: 0.026, 0.167) but had very wide CIs for blacks (0.016, CI: -0.224, 0.256) . Over-identification tests showed no evidence of possible pleiotropy in the genetic risk score. Conclusions: Our IV analysis reveals that genotypes associated with BMI are also associated with depressive symptoms in whites, supporting a causal effect of BMI on depression.
Keywords: Genetics; Health Conditions and Status; Public Policy

The Great Recession and Health: People, Populations, and Disparities - Sarah A. Burgard; Jennifer A Ailshire; Lucie Kalousova (Annals of the American Academy of Political and Social Science, 2013)
Two research traditions have evolved to assess links between recessions and health, with seemingly divergent findings. Aggregate-level studies generally find that mortality rates decline during recessionary periods. By contrast, individual-level studies generally find that events that frequently occur during recessions, like job loss, unemployment, and material hardship, carry negative health consequences. We comprehensively review evidence from these two bodies of research, illustrate key findings, and show how the different mechanisms can operate in parallel. We also outline some of the limitations of the extant evidence, discuss studies emerging to address these limits and directions for future research, and provide brief empirical examples to illustrate some of these limits and directions using the Health and Retirement Study and the Michigan Recession and Recovery Study. Our review emphasizes the importance of considering both the aggregate- and individual-level associations when evaluating the likely short- and longer-term consequences of the Great Recession for health and health disparities.
Keywords: Consumption and Savings; Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare; Public Policy; Retirement Planning and Satisfaction

Grip strength, multimorbidity, and disability - Amy M Yorke (Western Michigan University, 2013)
The presence of two or more chronic health conditions, also known as multimorbidity, is one of the most prevalent health disorders experienced by adults. Adults with multimorbidity and functional limitations represent clinical and financial challenges to the current health care system. The purpose of this three-paper dissertation is to examine the relationship between grip strength, multimorbidity, and the prediction of disability in adults. Data from the 2008 Health and Retirement Study (HRS), a nationally representative, longitudinal study completed on Americans age 50 years and over, are used for the dissertation. The objective of the first paper is to investigate the relationship between grip strength (measured in kilograms, kg) and chronic disease status. The results of this study indicate that when controlling for age and gender, as the number of chronic diseases increased, grip strength decreases. The findings are statistically significant. Grip strength normative values are computed for the second paper. Grip strength norms are stratified by gender (male, female), age (by decades), and chronic disease status (0, 1, 2, >3). The average grip strength for males ranges from 28.10 kg (80 years and older with three or more chronic diseases) to 46.81 kg (50-59 years with zero chronic diseases). Average right grip strength for females ranges from 16.76 kg (80 years and older with two chronic diseases) to 27.48 kg (50-59 years with zero chronic diseases). The third paper investigates a grip strength cutoff value that can be used to predict upper extremity (UE) or lower extremity (LE) disability in adults with and without multimorbidity. Receiver Operating Characteristic curves are calculated for sample, stratified by gender and chronic disease status. In summary, males without multimorbidity and a grip strength of<41kg and males with multimorbidity and a grip strength of <37 kg are anticipated to develop UE and LE disability. In females without multimorbidity and a grip strength of <25 kg and females with multimorbidity and a grip strength of <23 kg are anticipated to develop UE and LE disability.
Keywords: Health Conditions and Status; Healthcare; Other

Health and Functional Limitations Predict Depression Scores in the Health and Retirement Study: Results Straight from MARS - Robert F. Kennison; Cox, John (Californian Journal of Health Promotion, 2013)
To examine the effects of chronic health conditions and functional status limitations on depression scores in a large representative sample of Americans. Method: The data included 27,461 respondents ages 50 to 90 who completed up to eight test occasions from the Health and Retirement Study. Multivariate adaptive regression splines (MARS) modeling was applied. Possible covariates of depression included arthritis, lung disease, back pain, diabetes, heart disease, high blood pressure, cancer, 28 pairwise combinations of the aforementioned conditions, ADL functional limitations, age, education and being female, being white, and being Hispanic. Results: The best fitting model had a GRSq of 0.18 (comparable to R2) and included 12 of 42 covariates. Depression score was predicted by: 1) ADL limitations, 2) education, 3) back pain, 4) lung disease, 5) being female, 6) being Hispanic, 7) heart disease, 8) being white, 9) high blood pressure plus stroke, 10) age, 11) back pain plus arthritis, and 12) back pain plus diabetes. Conclusions: Functional limitations was the strongest predictor of depression; reporting one limitation increased depression scores by nearly double the increase associated with two or more limitations. Back pain and lung disease were the strongest chronic disease predictors of depression; both are associated with considerable discomfort.
Keywords: Health Conditions and Status; Methodology

Health and Wealth in Early Retirement - Geoffrey L Wallace; Haveman, Robert; Karen C. Holden; Barbara Wolfe (Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health, 2013)
Retirement years are a precarious time for many older Americans. Even if successful in accumulating resources expected to be sufficient to maintain their pre-retirement standard of living, many retirees face unexpected adverse health shocks after retirement. Because of the uncertainty of shocks to physical and cognitive health, there exists the potential for significant deterioration in resource adequacy both at the time of retirement and into the retirement years due to their occurrence. In this study, we select a sample of new retirees constructed from the Health and Retirement Study (HRS) data and follow them during the first decade of their retirement. Using these data, we identify the nature of shocks to physical and cognitive health for which individuals are at risk during their retirement years, and estimate both the absolute and relative risk of these shocks. We then estimate the impact of the occurrence of these shocks on wealth-based measures of retirement adequacy.
Keywords: Health Conditions and Status; Income; Retirement Planning and Satisfaction

Health, Education, and the Post-Retirement Evolution of Household Assets - James M. Poterba; Steven F Venti; David A Wise (Cambridge, MA, National Bureau of Economic Research, 2013)
This paper explores the relationship between education and the evolution of wealth after retirement. Asset growth following retirement depends in part on health capital and financial capital accumulated prior to retirement, which in turn are strongly related to educational attainment. These initial conditions for retirement can have a lingering effect on subsequent asset evolution. Our aim is to disentangle the effects of education on post-retirement asset evolution that operate through health and financial capital accumulated prior to retirement from the effects of education that impinge directly on asset evolution after retirement. We consider the indirect effect of education through financial resources in particular Social Security benefits and defined benefit pension benefits and through health capital that was accumulated before retirement. We also consider the direct effect of education on asset growth following retirement, emphasizing the correlation between education and the returns households earn on their post-retirement investments. Households with different levels of education invest, on average, in different assets, and they may consequently earn different rates of return. Finally, we consider the additional effects of education that are not captured through these pathways. Our empirical findings suggest a substantial association between education and the evolution of assets. For example, for two person households the growth of assets between 1998 and 2008 is on average much greater for college graduates than for those with less than a high school degree. This difference ranges from about 82,000 in the lowest asset quintile to over 600,000 in the highest.
Keywords: Demographics; Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction

Health, retirement, and migration from metro counties: evidence from the health and retirement study - Nan E. Johnson (Biodemography and Social Biology, 2013)
Event history analyses and difference-in-proportions tests are used to analyze 1994-2003 data from the Health and Retirement Survey. For young-old metropolitan adults who had never retired, self-rated health (SRH) was unrelated to the odds of becoming a migrant, but for those who had retired, better SRH raised the odds. Neither SRH nor its interwave change was related to the risk of a nonmetro or metro destination. Metro-metro and metro-nonmetro migrants were indistinguishable in their recalled reasons for migration. The implications of the findings for theory and future research are discussed.
Keywords: Demographics; Event History/Life Cycle; Health Conditions and Status; Retirement Planning and Satisfaction

Health shocks in patients with cancer: A longitudinal analysis of financial and retirement trends using the Health and Retirement study - Adrienne M. Gilligan (The University of Arizona, 2013)
Objectives: Evaluate the association of cancer on net worth, consumer debt, mortgage debt, home equity and changes in retirement trends. Methods: Data from the Health and Retirement Study from 1998-2010 was used. Persons had to have a diagnosis of cancer. The index date was the corresponding HRS wave of the year of the first diagnosis of cancer. The pre-index date was 2 years and a 2-year and 4-year post index was observed. Primary outcomes of interest were zero/negative net worth and net worth. Multiple logistic regression was used to test for the association between demographic, economic, human capital, and cancer-related variables on outcomes. Generalized linear models were conducted to assess the association of cancer on net worth, consumer debt, mortgage debt, and home equity. Multinomial logistic regression was performed to assess the association of cancer on retirement. Results: A total of 6,055,110 individuals (weighted) qualified. The majority of patients in this sample were male (53.8%), non-Hispanic (95.5%), and white (90.3%). Marital status (p<0.05), alcohol consumption (p=0.046), hypertension (p = 0.034), private insurance (p=0.001), cancer status (p<0.001), and cancer treatment (p=0.022) were significant predictors of zero/negative net worth 4-years after cancer diagnosis. Patients receiving treatment for their cancer were 71% more likely to have consumer debt 4-years post diagnosis (p=0.006). Patients who reported their cancer improving 4-years post diagnosis were significantly less likely (p=0.008) to have consumer debt (OR=0.59; 95%CI: 0.41-0.87). Cancer treatment and cancer status were significant predictors of mortgage debt (p<0.001 and 0.024, respectively). For individuals whose cancer either improved (OR=1.46; 95%CI: 1.04-2.06) or worsened (OR=4.09; 95%CI: 1.38-12.15), both groups were significantly more likely (p=0.030 and 0.011, respectively) to have home equity 4-years post diagnosis. Cancer status was a significant predictor of individuals transitioning from working to retired (p=0.022). Conclusion: This nationally representative investigation of 6.1 million patients over 50 years of age with cancer found that approximately 65% of cancer patients reported zero/negative net worth of cancer and almost 45% of cancer patients reported consumer debt four-years post diagnosis. Cancer-related characteristics explain a significant amount of the change in net worth four-years post diagnosis of cancer.
Keywords: Health Conditions and Status; Healthcare; Net Worth and Assets; Other; Public Policy; Retirement Planning and Satisfaction

Health Shocks in the Family: Gender Differences in Smoking Changes - Rachel Margolis (Journal of Aging and Health, 2013)
This study estimates the likelihood of starting and stopping smoking when respondents and their partners report new chronic illnesses. Analysis of longitudinal data from the Health and Retirement Study tests whether starting or stopping smoking is more likely when (a) the respondent, (b) their partner, (c) or both report a new chronic condition, and whether these patterns differ by gender. Both men and women are more likely to quit smoking when reporting a new chronic condition, relative to when reporting none. However only women are more likely to quit smoking when their partners fall ill. Women are also more likely than men to start smoking at this time. Among older couples, women's smoking changes are more sensitive to health shocks in the partnership. Interventions aimed at preventing unhealthy behaviors should pay attention to how each partner deals with the stress of health shocks.
Keywords: Demographics; Health Conditions and Status; Healthcare; Other; Women and Minorities

Health spending during Medicare coverage and associated health change - Yi-Sheng Chao; Chao-Jung Wu (Journal of Global Health Care Systems, 2013)
Introduction: Medicare spending growth is creating financial and fiscal issues in the US, but health returns from the spending under Medicare were not clear. This study aims to quantify the returns to mortality, self-rated health status and mental health, from the spending on health care in the first four years of Medicare coverage. Method: Eligible Medicare enrollees in the Health and Retirement Study (HRS) from 1992 to 2008 were chosen to understand the returns to health after four years of Medicare coverage, while controlling for individual characteristics before Medicare coverage (pre-Medicare characteristics). Ordered logit models were used for 4,099 eligible Medicare enrollees. Results: Health spending was associated with a higher likelihood of mortality in total spending model (n=1752, odds ratio OR =1.0044 per 1,000, p 0.01); out-of-pocket spending was not significant (n=4032, OR=1.0027 per 1,000, p=0.12). For health status, total and out-of-pocket spending were associated with worsening (n=1731, OR=1.0056, p=0.001; n=4029, OR=1.0154, p 0.01), while this association was confirmed for mental health only in total spending model (n=1658, OR=1.0018, p 0.001 and n=3922, OR=1.0029, p=0.06). Conclusion: there is an association between health spending and worsening of three health dimensions after first four years of Medicare coverage, as pre-Medicare characteristics also play a role in these health outcomes. Medicare could be more efficient in improving health outcomes if there are incentives to adopt effective care and a focus on the temporal externality from pre-Medicare health coverage and pre-Medicare characteristics.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance

Healthier, Wealthier, and Wiser: A Demonstration of Compositional Changes in Aging Cohorts Due to Selective Mortality - Zajacova, Anna; Sarah A. Burgard (Population Research and Policy Review, 2013)
The gradual changes in cohort composition that occur as a result of selective mortality processes are of interest to all aging research. We present the first illustration of changes in the distribution of specific cohort characteristics that arise purely as a result of selective mortality. We use data on health, wealth, education, and other covariates from two cohorts (the AHEAD cohort, born 1900-1923 and the HRS cohort, born 1931-1941) included in the Health and Retirement Survey, a nationally representative panel study of older Americans spanning nearly two decades (N = 14,466). We calculate sample statistics for the surviving cohort at each wave. Repeatedly using only baseline information for these calculations so that there are no changes at the individual level (what changes is the set of surviving respondents at each specific wave), we obtain a demonstration of the impact of mortality selection on the cohort characteristics. We find substantial changes in the distribution of all examined characteristics across the nine survey waves. For instance, the median wealth increases from about 90,000 to 130,000 and the number of chronic conditions declines from 1.5 to 1 in the AHEAD cohort. We discuss factors that influence the rate of change in various characteristics. The mortality selection process changes the composition of older cohorts considerably, such that researchers focusing on the oldest old need to be aware of the highly select groups they are observing, and interpret their conclusions accordingly. PUBLICATION ABSTRACT
Keywords: Health Conditions and Status; Methodology; Net Worth and Assets

How do couples influence each other's physical activity behaviours in retirement? An exploratory qualitative study - Barnett, Inka; Guell, Cornelia; Ogilvie, David (BMC Public Health, 2013)
Physical activity patterns have been shown to change significantly across the transition to retirement. As most older adults approach retirement as part of a couple, a better understanding of how spousal pairs influence each other's physical activity behaviour in retirement may help inform more effective interventions to promote physical activity in older age. This qualitative study aimed to explore and describe how couples influence each other's physical activity behaviour in retirement. A qualitative descriptive study that used purposive sampling to recruit seven spousal pairs with at least one partner of each pair recruited from the existing EPIC-Norfolk study cohort in the east of England, aged between 63 and 70 years and recently retired (within 2-6 years). Semi-structured interviews with couples were performed, audio-recorded, transcribed verbatim and analysed using data-driven content analysis. Three themes emerged: spousal attitude towards physical activity, spouses' physical activity behaviour and spousal support. While spouses' attitudes towards an active retirement were concordant, attitudes towards regular exercise diverged, were acquired across the life course and were not altered in the transition to retirement. Shared participation in physical activity was rare and regular exercise was largely an individual and independent habit. Spousal support was perceived as important for initiation and maintenance of regular exercise. Interventions should aim to create supportive spousal environments for physical activity in which spouses encourage each other to pursue their preferred forms of physical activity; should address gender-specific needs and preferences, such as chances for socialising and relaxation for women and opportunities for personal challenges for men; and rather than solely focusing on promoting structured exercise, should also encourage everyday physical activity such as walking for transport.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Methodology; Other; Public Policy; Retirement Planning and Satisfaction

How Do People Form Longevity Predictions? The Effect of Parents and Parents-in-law s Death on Beliefs about Mortality Risk - Chen, Lizi; Economics (Wellesley, MA, Wellesley College, 2013)
In this paper, we use data from the Health and Retirement Study (HRS) panel, which surveys a representative sample of US seniors about their longevity prospects to examine whether the Bayesian assumption holds. Specifically, I test for (1) whether people s longevity predictions are responsive to new information, e.g., recent parental death which conveys information about genetic risks, lifestyle-related health risks, etc; (2) whether people s longevity predictions respond more to the arrival of precise information (parental death) than less clear information (parent-in-law s death); (3) whether the magnitudes of these updates are in accordance with theoretical predictions. We find that individuals longevity predictions are responsive to new health-related information, and consistently more responsive to precise information (parental death) than imprecise information (parent-in-law s death). The magnitudes of these updates lie between the predicted lower and upper bounds of rational updates, but do not perfectly coincide with the predicted values and are sensitive to model specifications. We conclude that there is no strong evidence against the Bayesian assumption. We point out that the Bayesian assumption is only one aspect of the rationality hypothesis. From qualitative survey data, We find evidence of inattention to government subsidy of long-term care insurance, mistaken beliefs that long-term care is covered by Medicare and tendency to procrastinate on long-term care insurance purchasing decision. The evidence suggests irrationality may cause individuals to under-insure through these other venues.
Keywords: Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction

If My Blood Pressure Is High, Do I Take It To Heart? Behavioral Impacts of Biomarker Collection in the Health and Retirement Study - Ryan D. Edwards (Cambridge, MA, National Bureau of Economic Research, 2013)
Starting in 2006, respondents in the U.S. Health and Retirement Study were asked to submit biomarkers and were notified of certain results. Respondents with very high blood pressure were given a card during the interview; all respondents were notified by mail of their BP, hemoglobin A1c, and total and HDL cholesterol readings alongside recommended thresholds. About 5.8 percent received the high blood pressure card, and 5.4 percent had high A1c levels, an indicator of diabetes. Rates of undiagnosed high BP and diabetes according to these biomarkers were 1.5 and 0.7 percent. Average treatment effects of biomarker collection on the panel overall were effectively zero, but notification of rare and dangerous readings triggered new diagnoses, increased pharmaceutical usage, and altered health behaviors among small subsamples of respondents and their spouses. Very high BP or A1c readings raised new diagnosis and medication usage by 20 to 40 percentage points. Uncontrolled high BP triggered reductions in own smoking and own and spouse s drinking. High A1c was associated with a 2.2 percent drop in weight and an increase in exercise among respondents without a previous diagnosis of diabetes, but with no changes among those already diagnosed, whose self-reported health and disability worsened.
Keywords: Health Conditions and Status; Healthcare

Illness-related diabetes social support and glycemic control among middle aged and older adults - Mondesir, Favel L. (University of South Carolina, 2013)
Objective: The objective of this study is to investigate the association between illness-related diabetes social support (IRDSS) and glycemic control (GC) among a racially diverse sample of middle aged and older adults. In gender-stratified models we examine whether the relationship between IRDSS and GC is modified by race/ethnicity. Additionally, we explore the association between eight individual types of IRDSS and GC. Methods: We used the Health and Retirement Study (HRS) 2002 and the 2003 Diabetes Survey. The final analytic sample consisted of 914 study respondents. Gender-stratified multivariable logistic regression models were used to calculate odd ratios (ORs) and 95% confidence intervals (CIs) for the association between IRDSS and GC, test an interaction between race/ethnicity and IRDSS, and investigate the association between individual IRDSS variables and GC. Final models were adjusted for socio-demographic characteristics, lifestyle factors and clinical characteristics. Results: 79.5% and 76.7% of males and females respectively are classified as having adequate glycemic control. Among females, there was a significant association between IRDSS and GC (OR: 2.39; 95% CI: 1.44, 4.00), but no significant association was observed among males. There was a significant interaction between race/ethnicity and IRDSS (p-value < 0.10). Among Hispanic females, there was a higher odds (OR: 5.75; 95% CI: 1.01, 32.63) of adequate glycemic control in those who had high levels of IRDSS. The strongest association was found between high levels of emotional oriented social support and GC among females (OR=2.05; 95% CI: 1.18, 3.54). Conclusion: Our findings suggest that the relationship between IRDSS and GC varied by gender, where we only observed an association among females. Although we found a significant interaction between Hispanic race/ethnicity and IRDSS among females, our results should be interpreted with caution due to small sample sizes for the groups. We found that type of social support for self-care activities may play a role in achieving GC, where emotional support was most important. Further studies should aim at identifying factors which may determine gender differences in the association between IRDSS and GC. Race/ethnicity as an effect modifier of this association also needs further exploration in studies with larger sample sizes.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Methodology; Public Policy; Women and Minorities

Impact of social integration on metabolic functions: evidence from a nationally representative longitudinal study of US older adults - Yang Claire Yang; Li, Ting; Ji, Yinchun (Bmc Public Health, 2013)
Background: Metabolic functions may operate as important biophysiological mechanisms through which social relationships affect health. It is unclear how social embeddedness or the lack thereof is related to risk of metabolic dysregulation. To fill this gap we tested the effects of social integration on metabolic functions over time in a nationally representative sample of older adults in the United States and examined population heterogeneity in the effects. Methods: Using longitudinal data from 4,323 adults aged over 50 years in the Health and Retirement Study and latent growth curve models, we estimated the trajectories of social integration spanning five waves, 1998-2006, in relation to biomarkers of energy metabolism in 2006. We assessed social integration using a summary index of the number of social ties across five domains. We examined six biomarkers, including total cholesterol, high-density lipoprotein cholesterol, glycosylated hemoglobin, waist circumference, and systolic and diastolic blood pressure, and the summary index of the overall burden of metabolic dysregulation. Results: High social integration predicted significantly lower risks of both individual and overall metabolic dysregulation. Specifically, adjusting for age, sex, race, and body mass index, having four to five social ties reduced the risks of abdominal obesity by 61 (odds ratio OR 95 confidence interval Cl = 0.39 0.23, 0.67 , p = .007), hypertension by 41 (OR 95 Cl = 0.59 0.42, 0.84 , p = .021), and the overall metabolic dysregulation by 46 (OR 95 Cl = 0.54 0.40, 0.72 , p .001). The OR for the overall burden remained significant when adjusting for social, behavioral, and illness factors. In addition, stably high social integration had more potent metabolic impacts over time than changes therein. Such effects were consistent across subpopulations and more salient for the younger old (those under age 65), males, whites, and the socioeconomically disadvantaged. Conclusions: This study addressed important challenges in previous research linking social integration to metabolic health by clarifying the nature and direction of the relationship as it applies to different objectively measured markers and population subgroups. It suggests additional psychosocial and biological pathways to consider in future research on the contributions of social deficits to disease etiology and old-age mortality.
Keywords: Demographics; Health Conditions and Status; Other

The influence of working later in life on memory functioning - Kandauda Wickrama; Catherine W. O'Neal (Advances in Life Course Research, 2013)
This article examines the influence of work status on subsequent memory trajectories in later years. Using a subsample of 8165 older adults who participated in the Health and Retirement Study and were 65 years or older in 2002, we examined work status and memory functioning after controlling for age and demographic characteristics. In growth curve analyses, work status predicted the rate of immediate memory decline from 2002 to 2006 with full-time employed individuals showing less immediate memory decline after controlling for age. However, work status categories were not associated with subsequent age-adjusted delayed memory trajectories. The findings from these growth curve analyses support the hypothesis that working late in life helps to impede immediate memory declines that often occur in later years.
Keywords: Employment and Labor Force; Health Conditions and Status

Insomnia and Health Services Utilization in Middle-Aged and Older Adults: Results From the Health and Retirement Study - Christopher N Kaufmann; Sarah L. Canham; Ramin Mojtabai; Amber M Gum; Dautovich, Natalie D.; Kohn, Robert; Adam P Spira (The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2013)
Background. Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health care services, use of nursing homes, and use of any of these services in a population-based study of middle-aged and older adults.Methods. We studied 14,355 adults aged 55 and older enrolled in the 2006 and 2008 waves of the Health and Retirement Study. Logistic regression was used to study the association between insomnia symptoms (0, 1, or 2) in 2006 and reports of health service utilization in 2008, after adjustment for demographic and clinical characteristics.Results. Compared with respondents reporting no insomnia symptoms, those reporting one symptom had a greater odds of hospitalization (adjusted odds ratio AOR = 1.28, 95 confidence interval CI = 1.15 1.43, p .001), use of home health care services (AOR = 1.29, 95 CI = 1.09 1.52, p = .004), and any health service use (AOR = 1.28, 95 CI = 1.15 1.41, p .001). Those reporting greater than or equal to two insomnia symptoms had a greater odds of hospitalization (AOR = 1.71, 95 CI = 1.50 1.96, p .001), use of home health care services (AOR = 1.64, 95 CI = 1.32 2.04, p .001), nursing home use (AOR = 1.45, 95 CI = 1.10 1.90, p = .009), and any health service use (AOR = 1.72, 95 CI = 1.51 1.95, p .001) after controlling for demographics. These associations weakened, and in some cases were no longer statistically significant, after adjustment for clinical covariates.Conclusions. In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population.
Keywords: Health Conditions and Status; Healthcare; Public Policy

Investigating the relationship between recent dental visits, memory, and dementia risk factors - Carlson, Holly I. (Fielding Graduate University, 2013)
Research has concluded in recent years that oral health status is associated with dementia. However, little has been understood about how dental visits, which are a modifiable lifestyle variable, affect memory. The current study applied generalized estimating equations models to the RAND Health and Retirement Study nationally representative longitudinal database in order to determine whether recent dental visits predicted (a) higher memory scores, (b) subjective memory status, and (c) perceived change in self-rated memory. Results indicated that persons with recent dental visits obtained better episodic memory scores, had better self-rated memory, and reported perceived change in self-rated memory. The findings suggested that visiting the dentist and maintaining oral health are crucial for healthy cognitive aging. It is concluded that older adults should regularly visit the dentist in order to maintain memory capabilities.
Keywords: Gerontology; Health Conditions and Status; Healthcare; Methodology; Risk Taking

Labor Force Transitions at Older Ages: The Roles of Work Environment and Personality - Marco Angrisani; Michael D Hurd; Erik Meijer; Andrew M Parker; Susann Rohwedder (Ann Arbor, The University of Michigan, 2013)
Besides compensation and financial incentives, several other work-related factors may affect individual retirement decisions. Specifically, job characteristics such as autonomy, skill variety, task significance and difficulty, stress and physical demands, peer pressure and relations with co-workers, play a crucial role in determining psychological commitment to work at older ages. While financial preparedness for retirement and health shocks are often cited as main predictors of the choice to exit the labor force, there exists relatively little research documenting the extent to which the work environment itself and its interaction with economic variables influence retirement decisions. We document that job characteristics are associated with labor force transitions at older ages, in particular transitions to retirement and part-time employment. Additionally, we show that while personality traits do not directly drive labor force transitions, the effect of job characteristics on labor supply outcomes varies with the intensity of personality traits. We also document that job characteristics themselves are strongly related to personality traits. This suggests that, depending on their personality, individuals may select into specific jobs, whose characteristics ultimately shape their retirement paths.
Keywords: Employment and Labor Force; Health Conditions and Status; Other; Retirement Planning and Satisfaction

Labor outcomes of health shocks and dependent coverage expansions - Burgdorf, James R., Jr. (The Pardee RAND Graduate School, 2013)
The traditional bundling of health insurance with employment in the United States may distort workers' labor market choices by encouraging full-time wage and salary employment relative to part-time work, self-employment, and not working. However, disentangling the effects of employer-provided health insurance on labor market outcomes is a challenging empirical issue. To overcome this issue, I conduct three studies which exploit three sources of variation in individual valuation of employer-provided group health care. The first study considers the differential impact of health shocks on self-employed workers and wage and salary workers using panel data from the Health and Retirement Study. I find that among older workers in perfect health, health shocks have a larger effect on exits from self-employment than on exits from wage and salary work, implying that extending group coverage to small firm owners may reduce the number of health-related firm failures. The second study uses data from the Current Population Survey's Annual Social and Economic Supplement (ASEC), and was originally intended to examine the effect of state-level dependent coverage expansions on employment outcomes for young adults. Instead, I uncover new evidence that these reforms have had a more limited impact on young adults' insurance rates than indicated by previous research. The third study again uses ASEC data, but considers the effects of the Affordable Care Act's federal-level dependent coverage expansion on young adults' labor market outcomes. I find that these reforms did effectively increase the reported holding of non-spousal dependent coverage, and initial results indicate a significant association with reduced labor force participation. However, further investigation reveals that the target population's relative withdrawal from the labor force began prior to the implementation of the insurance reform, and is likely driven by the economic recession. ii
Keywords: Employment and Labor Force; Health Conditions and Status; Healthcare; Insurance; Medicare/Medicaid/Health Insurance; Methodology; Public Policy

Leaving Retirement: Age-Graded Relative Risks of Transitioning Back to Work or Dying - Ben Lennox Kail; David F Warner (Population Research and Policy Review, 2013)
Demographic research has documented the age-graded risk of returning to work after a period of retirement; few studies, however, have disaggregated this risk into the different forms work takes in later life. Moreover, prior research has not explored the age-graded risk of re-retiring after reentry. This study uses the 1992-2008 Health and Retirement Study to first examine the age-graded and duration dependent risks of transitioning to full-time work, part-time work, and mortality from full retirement. Second, this study documents the age-graded duration of reemployment, and the age-graded risk of re-retiring. Results from multi-decrement life tables indicate reemployment both occurs more frequently and lasts longer than previously estimated. The gender differences in risk of reemployment are modest, although women are at greater risk of returning to part-time work, whereas men are at greater risk of returning to full-time work. Additionally, retirees from services-producing industries are at lower risk of transitioning to work, but greater risks of mortality, suggesting retirement is a less permanent feature in the life course of retirees from goods-producing industries. Finally, the results suggest Social Security benefit eligibility plays a part in reducing reentry at later ages.
Keywords: Employment and Labor Force; Health Conditions and Status; Methodology; Public Policy; Retirement Planning and Satisfaction; Risk Taking

The Life Care Annuity: A New Empirical Examination of an Insurance Innovation That Addresses Problems in the Markets for Life Annuities and Long-Term Care Insurance - Brown, Jason; Mark J. Warshawsky (Journal of Risk and Insurance, 2013)
The integration of the life annuity with long-term care insurance coverage is intended to deal with major problems in the currently separate markets for life annuities and long-term care insurance. The integration would allow the inclusion of most of the population currently rejected by underwriting those in poor health or lifestyles but who would not go immediately into long-term care claim who also have lower life expectancies. We make use of the Health and Retirement Study, on individuals in retirement and their disability incidence, exploiting the panel nature of the survey to estimate transition probabilities in and out of disability states according to numerous demographic and health characteristics. This allows for analysis of disability and mortality risk across a number of dimensions. We find that different risk groups at age 65 have similar projected long-term care expenses, but that the level-periodic-premium structure of most long-term care insurance policies creates incentives for individuals to separate into different risk pools according to observable characteristics, justifying the underwriting observed on the market. Yet we also find that gender-rated life care annuities could succeed in pooling risks currently segmented in the market for long-term care insurance, thus qualifying individuals at or near retirement for permanent long-term care insurance coverage who do not currently qualify, and allowing for life annuities to be purchased more cheaply than in the stand-alone annuity market now subject to adverse selection.
Keywords: Disabilities; Health Conditions and Status; Insurance; Medicare/Medicaid/Health Insurance; Net Worth and Assets

Life expectancy as a constructed belief: Evidence of a live-to or die-by framing effect - Payne, John W.; Sagara, Namika; Shu, Suzanne B.; Appelt, Kirstin C.; Johnson, Eric J (Journal of Risk and Uncertainty, 2013)
Life expectations are essential inputs for many important personal decisions. We propose that longevity beliefs are responses constructed at the time of judgment, subject to irrelevant task and context factors, and leading to predictable biases. Specifically, we examine whether life expectancy is affected by the framing of expectations questions as either live-to or die-by, as well as by factors that actually affect longevity such as age, gender, and self-reported health. We find that individuals in a live-to frame report significantly higher chances of being alive at ages 55 through 95 than people in a corresponding die-by frame. Estimated mean life expectancies across three studies and 2300 respondents were 7.38 to 9.17 years longer when solicited in a live-to frame. We are additionally able to show how this framing works on a process level and how it affects preference for life annuities. Implications for models of financial decision making are discussed. PUBLICATION ABSTRACT
Keywords: Expectations; Health Conditions and Status; Healthcare; Methodology; Net Worth and Assets; Retirement Planning and Satisfaction

Linking Perceived Control, Physical Activity, and Biological Health to Memory Change - Frank J Infurna; Denis Gerstorf (Psychology and Aging, 2013)
Perceived control plays an important role for remaining cognitively fit across adulthood and old age. However, much less is known about the role of perceived control over and above common correlates of cognition, and possible factors that underlie such control-cognition associations. Our study examined whether perceived control was predictive of individual differences in subsequent 4-year changes in episodic memory, and explored the mediating role of physical activity and indicators of physical fitness, cardiovascular, and metabolic health for control-memory associations. To do so, we used longitudinal data from the nationwide Health and Retirement Study (HRS; N = 4,177; ages 30 to 97 years; 59 women). Our results show that perceiving more control over one's life predicted less memory declines, and this protective effect was similar in midlife and old age. We additionally observed that higher levels and maintenance of physical activity over 2 years, better pulmonary function, lower systolic blood pressure (SPB), lower hemoglobin A(1c), and higher high-density lipoprotein cholesterol (HDL-C) also predicted less memory declines. Mediation analyses revealed that levels of, and 2-year changes in, physical activity, as well as levels of pulmonary function and hemoglobin A1c and HDL-C, each uniquely mediated control-memory change associations. Our findings illustrate that perceived control, physical activity, and indicators of physical fitness and cardiovascular and metabolic health moderate changes in memory, and add to the literature on antecedents of cognitive aging by conjointly targeting perceived control and some of its mediating factors. We discuss possible pathways underlying the role of control for memory change and consider future routes of inquiry to further our understanding of control-cognition associations in adulthood and old age.
Keywords: Event History/Life Cycle; Health Conditions and Status; Healthcare; Other

Longer Term Effects of Total Knee Arthroplasty From a National Longitudinal Study - Frank A Sloan; Linda K George; Hu, Linyan (Journal of Aging and Health, 2013)
This study used data for 1996-2010 from a U.S. longitudinal sample of elderly individuals from the Health and Retirement Study (HRS) merged with Medicare claims data to assess changes in several dimensions of physical functioning and general health up to 68 months following total knee arthroplasty (TKA) receipt. Using propensity score matching, we assessed outcomes at follow-up for Medicare beneficiaries receiving TKA and a comparable group of beneficiaries with the same osteoarthritis diagnoses (controls). Receipt of TKA was most often associated with improvements in physical functioning, especially in physical functioning measures most directly related to the knee. General health of TKA recipients only improved relative to controls on 1 of the 3 study general health measures. Improvements in physical functioning of TKA recipients persisted in this longer term analysis of outcome in a nationally representative population study.
Keywords: Demographics; Health Conditions and Status; Healthcare

The Long-Term Costs of Caring: How Caring for an Aging Parent Impacts Wealth Trajectories of Caregivers - Jennifer C. Greenfield (Washington University in St. Louis, 2013)
Long-term care in the U.S. is a growing concern as our aging population exerts pressure on formal and informal care systems. Public expenditures on formal care are increasing rapidly, even as reliance on informal caregivers expands. Recent policy innovations are shifting Medicaid and Medicare funding toward home- and community-based services (HCBS) as an alternative to nursing home care. This may help reduce overall LTC care costs to states and the federal government, but it also shifts more responsibility to families and informal care networks. Not only can caregiving have negative impacts on the physical and mental health of caregivers, but it also can be expensive, both in terms of direct costs and in terms of lost wages and work opportunities. However, to date, these financial consequences are not fully understood. This project uses longitudinal, nationally representative data from six waves of the Health and Retirement Study (1998-2008) to evaluate whether caring for aging parents impacts caregivers' assets over time. Latent trajectory analysis was used to identify groups for whom caregiving had a negative impact on wealth trajectories. A four-group model fit best and revealed one group, with 4.3% of respondents, for whom caregiving had a significant, negative relationship. Further, race, education, and caregivers' health were significantly related to these trajectories. Gender and marital status were not related. Lastly, among caregivers, care duration did not significantly impact asset trajectories, and care intensity had mixed effects. Findings indicate that caring for an aging parent has a significant, negative impact for some adults over age 50, but only for a small group. Importantly, those who are negatively impacted are more likely to be in already vulnerable groups. As reliance on informal caregiving increases, special attention should be paid to those caregivers who may be particularly vulnerable to the financial impacts of caregiving; better assessments and more economic supports are needed to offset the potential exacerbating impacts of caregiving.
Keywords: Adult children; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Net Worth and Assets

Managing retirement resources: evidence from the HRS - Chris Browning (Texas Tech University, 2013)
Households are required to make a variety of decisions in pursuit of their retirement goals. These decisions are often complex and require the estimation and input of multiple factors when analyzing alternatives. Complexity and uncertainty have been found to lead to behavioral biases and a dependence on heuristics when making decisions. These deficiencies create a failure to incorporate valuable information, an overreliance on recent events, and inaccurate estimations of future outcomes. When these factors are combined with widespread low levels of financial sophistication and declining cognition the result is often behavior that is contradictory to rational expectations and detrimental to lifetime wealth and utility. Households are bound at a variety of levels by the limitations described above. Sophisticated households and those with higher levels of cognitive ability are more likely to participate in financial markets, enjoy higher returns on investments, and greater levels of wealth. Those with less sophistication and cognitive ability may fail to understand complex financial products, have less consistent preferences, and be more likely to engage in behavior that is inconsistent and detrimental to long-term goals and overall well-being. Given the variation in levels of financial sophistication and cognitive ability, we seek to evaluate how households make decisions in the face of market complexity, and in some cases how these decisions affect financial outcomes. Using the Health and Retirement Study (HRS) we give special focus to the decisions and behavior of older households. We look specifically at the impact of financial sophistication on individuals' ability to accurately value life annuities, how cognitive ability is related to stock reallocations during the great recession, and how cognitive ability relates to the asset decumulation decisions of retirees.
Keywords: Expectations; Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction

Marital Processes around Depression: A Gendered and Relational Perspective - Thomeer, Mieke Beth; Debra Umberson; Tetyana Pudrovska (Society and Mental Health, 2013)
Despite extensive evidence of the importance of marriage and marital processes for mental health, little is known about the interpersonal processes around depression within marriage and the extent to which these processes are gendered. We use a mixed-methods approach to explore the importance of gender in shaping processes around depression within marriage. We approach this in two ways: First, using quantitative longitudinal analysis of 2,601 couples from the Health and Retirement Study (HRS), we address whether depressive symptoms in one spouse shape the other spouse s depressive symptoms and whether men or women are more influential in this process. We find that a wife s depressive symptoms influence her husband s future depressive symptoms, but a husband s depressive symptoms do not influence his wife s future symptoms. Second, we conduct a qualitative analysis of in-depth interviews with 29 couples wherein one or both spouses experienced depression to provide additional insight into how gender impacts depression and reactions to depression within marriage. Our study points to the importance of cultural scripts of masculinity and femininity in shaping depression and emotional processes within marriage and highlights the importance of applying a gendered couple-level approach to better understand the mental health effects of marital processes.
Keywords: Adult children; Demographics; Health Conditions and Status

Marriage and Wealth Changes at Older Ages - Julie M Zissimopoulos (Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health, 2013)
This chapter presents an examination of the impact on net worth and savings of changes in family structure at older ages. The analysis demonstrates that married couples have more wealth than unmarried individuals primarily due to the higher lifetime earnings and lower mortality risk of married couples compared to unmarried individuals. Divorce at older ages both divides and consumes wealth and has negative and long-lasting consequences on wealth accumulation while remarriage rebuilds assets.
Keywords: Adult children; Event History/Life Cycle; Health Conditions and Status; Income; Net Worth and Assets

Mechanisms of the effect of involuntary retirement on older adults' health and mental health - Min-Kyoung Rhee (University of Southern California, 2013)
The purpose of the present study is to provide in-depth information on older adults' experience of involuntary retirement by examining mechanisms of the effect of involuntary retirement on self-rated health and mental health among adults aged 50 years or older. Although it is a normative expectation to perceive retirement as a phase of life in which older adults become disengaged from paid work, volunteer, and enjoy leisure time with family, not everyone has the luxury of maintaining control over their retirement decisions. Approximately one third of retirees perceive their retirement as forced rather than voluntary. Involuntary retirees are likely to face greater challenges than voluntary retirees during their postretirement adjustment period because they have multiple burdens of health, mental health, and job displacement issues that may have partially led them to involuntarily retire. The prevalence of involuntary retirement is likely to increase because older adults are expected to work longer due to increased financial responsibility despite the challenge of securing or maintaining employment. Although an expanding body of research has addressed various topics of retirement including preretirement planning and decision making, relatively few studies on retirement have focused on the voluntariness of retirement or its varied contexts. Research that has explored health and mental health outcomes after retirement without accounting for voluntariness has reported mixed findings. Considering the fact that retirement has become a more complex and diverse life transition, it is critical to consider the nature of retirement as well as its contexts. To fill this gap of knowledge in research and practice, this study had two specific aims: (1) to explore the prevalence of involuntary retirement among older adults and the extent to which the characteristics of involuntary retirees are different from voluntary retirees or those who did not retire, and (2) to investigate the mechanisms of the health and mental health effect of involuntary retirement by examining the potential mediating effects of financial control, positive and negative family relationships, and social integration. The research questions and hypotheses were formulated based on the life course perspective and latent deprivation theory. Using two waves of longitudinal data extracted from Health and Retirement Study (2006 and 2010), a final sample of 1,280 individuals working for pay at baseline who responded to a lifestyle questionnaire in both waves was selected. Univariate, bivariate, and regression-based path analyses were conducted using SPSS 18.0. This study employed a multiple mediation model that considered four mediators simultaneously and the model was estimated in three phases. Results of the study found that 29.3% (n = 429) of the sample retired between 2006 and 2010, and 37.2% (n = 155) of those individuals reported that they retired involuntarily. Results of Phase 1, a multiple mediator model that did not account for voluntariness of retirement using a binary independent variable (retired or not), indicated that there was no significant direct or indirect effects of retirement on self-rated health and mental health outcomes. In Phase 2, in which the same model was estimated using a multicategorical independent variable (involuntarily retired, voluntarily retired, not retired), involuntary retirement had an direct adverse health effect compared to not retiring, whereas voluntary retirement had an indirect positive health effect via financial control. In terms of mental health outcomes, the positive mental health effect of voluntary retirement was mediated by financial control, whereas involuntary retirement had no significant effect. Results of Phase 3, a model that considered retirees only, revealed direct adverse health effects of involuntary retirement compared to voluntary retirement. Involuntary retirement also had an indirect effect on mental health via financial control. Findings of this stu y indicate the significance of specifying the nature of retirement when conducting retirement research and the need to pay more attention to potential detrimental effects of involuntary retirement. Implications of the findings are discussed with regard to retirement policy, research, and social work.
Keywords: Health Conditions and Status; Healthcare; Methodology; Other; Public Policy; Retirement Planning and Satisfaction

Mental and physical health consequences of spousal health shocks among older adults - Valle, Giuseppina; Weeks, Janet A.; Miles G Taylor; Eberstein, Isaac W. (Journal of Aging and Health, 2013)
OBJECTIVE: To examine how the experience of a negative health event (i.e., onset of heart disease, diabetes, lung disease, cancer, or stroke) of one spouse affects the mental and physical well-being of the other partner as measured by depressive symptoms and self-reported health. METHODS: We employ latent growth curve analysis and examine adults 50 using six waves of data (1998-2008) from the Health and Retirement Study. RESULTS: One spouse's health shock affects the health of the other partner. Results indicate that a spouse's onset of a severe health condition worsens the mental health of women and the self-reported health of men. DISCUSSION: These findings illustrate that the family context of spouses is important to consider when examining health.
Keywords: Demographics; Health Conditions and Status

Mental retirement and schooling - Bingley, Paul; Martinello, Alessandro (European Economic Review, 2013)
We assess the validity of differences in eligibility ages for early and old age pension benefits as instruments for estimating the effect of retirement on cognitive functioning. Because differences in eligibility ages across country and gender are correlated with differences in years of schooling, which affect cognitive functioning at old ages, they are invalid as instruments without controlling for schooling. We show by means of simulation and a replication study that unless the model incorporates schooling, the estimated effect of retirement is negatively biased. This explains a large part of the mental retirement effects which have recently been found.
Keywords: Cross-National; Health Conditions and Status; Methodology; Other; Retirement Planning and Satisfaction

Methods for Analysis of the Financing and Use of Long-Term Services and Supports - United States Congressional Office (Washington, DC, 2013)
This document describes the data and methods underlying the 23 exhibits presented in Congressional Budget Office, Rising Demand for Long-Term Services and Supports for Elderly People (June 2013). Most of the statistics presented in Rising Demand for Long-Term Services and Supports for Elderly People are based on tabulations of data from the Health and Retirement Study (HRS, http://hrsonline.isr.umich.edu/) and the Access to Care files of the Medicare Current Beneficiary Survey (MCBS, http://go.usa.gov/b7TP). The statistics are population-weighted averages of measurements taken from the data available in those surveys from 2000 to 2010.
Keywords: Health Conditions and Status; Healthcare; Methodology; Public Policy

Modelling and predicting complex patterns of change using growth component models: An application to depression trajectories in cancer patients - Axel Mayer; Geiser, Christian; Frank J Infurna; Fiege, Christiane (European Journal of Developmental Psychology, 2013)
In this paper we present a general and flexible framework for constructively defining growth components to model complex change processes. Building on the concepts of the latent state-trait theory (LST theory; Steyer, Ferring, and Schmitt, 1992), we develop structural equation models containing latent variables that represent latent growth (change) components of interest. We formulate these models based on an approach presented by Mayer, Steyer and Mueller (2012). We discuss an application to the longitudinal course of depression in 2,794 individuals from the Health and Retirement Study, who experienced cancer diagnosis over the course of the study. We found that (1) on average, the depression trajectories showed a steep increase after diagnosis as well as an adaptation phase where levels returned back to levels prior to diagnosis, and (2) individual differences in change were large and could be partly explained by marital status and cognitive functioning.
Keywords: Health Conditions and Status; Methodology; Public Policy

Moving Considerations: A Longitudinal Analysis of Parent-Child Residential Proximity for Older Americans - Zhang, Yiduo; Michal Engelman; Emily M. Agree (Research on Aging, 2013)
Residential proximity is an important indicator of family members' availability to provide assistance to each other. We investigate proximity-enhancing moves by older parents and their children and the reasons for such moves. Using the 2000-2004 waves of the Health and Retirement Study, we fit multinomial logit models examining 2-year residential transitions for parents and children living 10 or more miles apart at baseline. Our results show that family members collectively adjust intergenerational proximity to facilitate mutual support. Despite the common assumption that older parents move closer to their children to receive assistance, more than two thirds of all proximity-enhancing moves are made by adult children. While greater anticipated longevity raises the probability that older parents will move closer to their children, parents' anticipated longevity does not influence children's moving decisions. Including individual variability in anticipated longevity in the life course framework helps account for relocation that precedes declines in health or increases in the need for support.
Keywords: Adult children; Demographics; Event History/Life Cycle; Expectations; Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

A multistate transition model for analyzing diseases in elderly population - Noor, Norlida Mohd; M. Ataharul Islam; Zalila Ali (World Applied Sciences Journal, 2013)
In this study, a competing risk model is proposed to analyze the transitions to diseases among elderly people employing the proportional hazards model. This study provides important findings regarding the disease pattern among the elderly people and the factors associated with such transitions. The Health and Retirement Study data are considered for the period of 1992-2000. The major diseases or complications considered in this study are stroke, lung diseases, diabetes mellitus, blood pressure and arthritis. The transitions to different diseases or complications are explained by selected covariates such as gender, race, marital status, smoking, drinking, physical exercise and BMI. The results indicate that gender, race, smoking and BMI are significantly associated with transitions to different diseases or complications. The results are displayed for transitions to each disease or complication separately for competing risk framework as well as for the combined transition to any of the selected diseases or complications. This paper reveals some important health issues related to the transitions to the selected diseases or complications among the elderly people and the factors associated with such transitions are identified.
Keywords: Demographics; Health Conditions and Status; Methodology; Other; Risk Taking

The Nature and Correlates of Change in Depressive Symptoms With Cancer Diagnosis: Reaction and Adaptation - Frank J Infurna; Denis Gerstorf; Ram, Nilam (Psychology and Aging, 2013)
Major life events trigger change processes in mental health. We examined how depressive symptoms change in conjunction with cancer diagnosis during adulthood and old age, and whether sociodemographic variables, cognitive and health resources, and cancer-specific mortality risks moderate event-related reaction and adaptation. Specifically, we applied multiphase growth models to prospective longitudinal data from 2,848 participants (age at diagnosis: M = 69, SD = 9.91; 46 women) in the Health and Retirement Study (HRS) who reported receiving a cancer diagnosis while enrolled in the study. On average, individuals experienced a significant increase in depressive symptoms within 2 years of cancer diagnosis, still-elevated levels 2 years postdiagnosis, and smaller increases in depressive symptoms postdiagnosis relative to the increases observed prediagnosis. Better memory and lower cancer-specific mortality risks were protective against increases in depressive symptoms within 2 years of diagnosis and were associated with reporting fewer depressive symptoms 2 years postdiagnosis. Findings suggest that diagnosis-related changes in depressive symptoms are typically characterized by a multiphase pattern, but tremendous between-person differences also emerged within each phase. Follow-up analyses comparing a matched group (N = 2,272) who did not experience cancer provided an additional layer of evidence supporting our inferences. Results indicate that, on average, people adapt and adjust to the challenges accompanying a cancer diagnosis, and illustrate the utility of using natural experiments such as major life events as a paradigm for studying developmental change processes.
Keywords: Event History/Life Cycle; Expectations; Health Conditions and Status; Methodology

Neighborhood racial residential segregation and changes in health or death among older adults - Joseph J Sudano; Perzynski, Adam; Wong, David W.; Colabianchi, Natalie; Litaker, David (Health and place, 2013)
We assessed relationships between neighborhood racial residential segregation (RRS), individual-level health declines and mortality using Health and Retirement Study data. We calculated the census-tract level Location Quotient for Racial Residential Segregation (LQRRS), and estimated adjusted relative risks (ARR) of LQRRS for declines in self-reported health or death 1992-2000, controlling for individual-level characteristics. Of 6653 adults, 3333 lived in minimal, 2242 in low, 562 in moderate, and 516 in high LQRRS tracts in 1992. Major decline/death rates were: 18.6 , 25.2 , 33.8 and 30.4 in minimal, low, moderate and high tracts, respectively. Adjusting for demographic characteristics, residence in low, moderate and high LQRRS census tracts was associated with greater likelihood of major decline/death compared to minimal LQRRS. Controlling for all variables, only moderate LQRRS predicted major decline/death, ARR=1.31 (95 CI 1.07, 1.59; p .05).
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology; Public Policy; Women and Minorities

New insights into the dementia epidemic. - Eric B Larson; Kristine Yaffe; Kenneth M. Langa (New England Journal of Medicine, 2013)
Keywords: Aging; Cognitive Ability; Dementia; Health Conditions and Status; Older Adults

New Measures of Fluid Intelligence in the HRS - Gwenith G Fisher; John J McArdle; Ryan J McCammon; Amanda Sonnega; David R Weir (Institute for Social Research, University of Michigan, 2013)
This user guide describes how measures designed to test quantitative reasoning, verbal reasoning and verbal fluency were implemented in the 2010 and 2012 waves of the Health and Retirement Study. The Number Series test and Retrieval Fluency test were administered in the 2010 and 2012 waves of HRS to the full sample. The Verbal Analogies test was administered to a 10 percent random sample of the full HRS sample in 2012. Number Series measures quantitative reasoning, a specific type of fluid cognitive ability or fluid intelligence. Quantitative reasoning ability involves reasoning with concepts that depend upon mathematical relationships. The number series task requires the respondent to look at a series of numbers with a number missing from the series. The respondent must determine the numerical pattern and then provide the missing number in the series. Retrieval Fluency measures an aspect of long-term retrieval : fluency of retrieval from stored knowledge. It was first incorporated in the HRS in the 2010 wave . This test is a typical neuropsychology test and was adapted by McArdle and Woodcock from the WJ-III Tests of Achievement: Retrieval Fluency ( Riverside Publishing). The measure consisted of a single item in which respondents were asked to name as many animals as they could within a 60-second time limit. This measure is consistent with animal fluency measures commonly administered in other neuropsychological exams (e.g., the CERAD animal fluency measure; Morris et al., 1989) . Administration protocols, test scoring, and data quality review procedures are discussed for each measure.
Keywords: Health Conditions and Status; Methodology

Obesity and Mortality Risk: New Findings From Body Mass Index Trajectories - Hui Zheng; Dmitry Tumin; Qian, Zhenchao (American Journal of Epidemiology, 2013)
Little research has addressed the heterogeneity and mortality risk in body mass index (BMI) trajectories among older populations. Applying latent class trajectory models to 9,538 adults aged 51 to 77 years from the US Health and Retirement Study (1992 2008), we defined 6 latent BMI trajectories: normal weight downward, normal weight upward, overweight stable, overweight obesity, class I obese upward, and class II/III obese upward. Using survival analysis, we found that people in the overweight stable trajectory had the highest survival rate, followed by those in the overweight obesity, normal weight upward, class I obese upward, normal weight downward, and class II/III obese upward trajectories. The results were robust after controlling for baseline demographic and socioeconomic characteristics, smoking status, limitations in activities of daily living, a wide range of chronic illnesses, and self-rated health. Further analysis suggested that BMI trajectories were more predictive of mortality risk than was static BMI status. Using attributable risk analysis, we found that approximately 7.2 of deaths after 51 years of age among the 1931 1941 birth cohort were due to class I and class II/III obese upward trajectories. This suggests that trajectories of increasing obesity past 51 years of age pose a substantive threat to future gains in life expectancy.
Keywords: Demographics; Health Conditions and Status

Optimism, pessimism and bias in self-reported body weight among older adults - Angelina R Sutin (Obesity, 2013)
Objective: Body mass index (BMI) and obesity (BMI 30) are often derived from self-reported weight and height; psychological dispositions may bias how participants report these physical characteristics. The present research used a large national sample of US adults to examine the correspondence between reported and measured body weight and height and to test whether optimists and pessimists misreport their weight/height in ways that are consistent with their worldviews. Methods: Participants in the Health and Retirement Study (N = 11,207) reported their weight and height and completed a measure of dispositional optimism and pessimism; trained interviewers measured participants weight and height. Results: There was a high correlation between measured and reported weight (r = 0.98) and height (r = 0.92). Consistent with their positive and negative worldviews, respectively, optimists under-reported and pessimists over-reported their weight. There was not a consistent association with misreported height. Optimism and pessimism were also associated with actual BMI and risk of obesity, but the protective/risk effects were amplified when using reported weight to derive BMI. Conclusions: These findings suggested that reported body weight tends to be accurate, but that biases associated with psychological dispositions may inflate the relation between the disposition and obesity. Such biases may extend to associations with other self-reported factors thought to be related to optimism and pessimism.
Keywords: Health Conditions and Status; Healthcare; Other

Pain and Use of Alcohol in Later Life: Prospective Evidence from the Health and Retirement Study - Penny L. Brennan; SooHoo, Sonya (Journal of Aging and Health, 2013)
To determine whether (a) late-life pain predicts growth in older adults' use of alcohol, and elevated risk of drinking problems; and (b) sociodemographic characteristics moderate these relationships. Five times over an 8-year interval, N = 5,446 Health and Retirement Study (HRS) participants provided information about their pain and alcohol use. Two-part latent growth modeling and logistic regression were used to analyze these data. Participants with more pain at baseline had lower initial levels and a faster rate of decline over the next 8 years in alcohol consumption, but they also were at elevated risk of having drinking problems. Income and African American background interacted with pain to predict 8-year change in alcohol consumption and presence of drinking problems. Late-life pain does not predict growth in older adults' alcohol consumption, but is nonetheless linked to elevated risk of drinking problems, especially among African Americans.
Keywords: Demographics; Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

A parsimonious model of subjective life expectancy - Ludwig, Alexander; Zimper, Alexander (Theory and Decision, 2013)
On average, young people underestimate whereas old people overestimate their chances to survive into the future. Such subjective survival beliefs violate the rational expectations paradigm and are also not in line with models of rational Bayesian learning. In order to explain these empirical patterns in a parsimonious manner, we assume that self-reported beliefs express likelihood insensitivity and can, therefore, be modeled as non-additive beliefs. In a next step we introduce a closed form model of Bayesian learning for non-additive beliefs which combines rational learning with psychological attitudes in the interpretation of information. Our model gives a remarkable fit to average subjective survival beliefs reported in the Health and Retirement Study.
Keywords: Expectations; Health Conditions and Status; Methodology; Other

Perceived neighborhood social cohesion and stroke - Eric S Kim; Nansook Park; Christopher Peterson (Social Science and Medicine, 2013)
Research in the last three decades has shown that negative neighborhood factors such as neighborhood violence, noise, traffic, litter, low neighborhood socioeconomic status, and poor air quality increase the risk of poor health. Fewer studies have examined the potential protective effect that neighborhood factors can have on health, particularly stroke. We examined whether higher perceived neighborhood social cohesion was associated with lower stroke incidence after adjusting for traditional risk and psychological factors that have been linked with stroke risk. Prospective data from the Health and Retirement Study-a nationally representative panel study of American adults over the age of 50-were used. Analyses were conducted on a subset of 6740 adults who were stroke-free at baseline. Analyses adjusted for chronic illnesses and relevant sociodemographic, behavioral, and psychosocial factors. Over a four-year follow-up, higher perceived neighborhood social cohesion was associated with a lower risk of stroke. Each standard deviation increase in perceived neighborhood social cohesion was associated with a multivariate-adjusted odds ratio (O.R.) of 0.85 for stroke incidence (95 Cl, 0.75-0.97, p 0.05). The effect of perceived neighborhood social cohesion remained significant after adjusting for a comprehensive set of risk factors. Therefore, perceived neighborhood social cohesion plays an important role in protecting against stroke. (C) 2013 Elsevier Ltd. All rights reserved.
Keywords: Demographics; Health Conditions and Status; Healthcare; Public Policy

Perceived Weight Discrimination and Obesity - Angelina R Sutin; Antonio Terracciano (PLoS One, 2013)
Weight discrimination is prevalent in American society. Although associated consistently with psychological and economic outcomes, less is known about whether weight discrimination is associated with longitudinal changes in obesity. The objectives of this research are (1) to test whether weight discrimination is associated with risk of becoming obese (Body Mass Index 30; BMI) by follow-up among those not obese at baseline, and (2) to test whether weight discrimination is associated with risk of remaining obese at follow-up among those already obese at baseline. Participants were drawn from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US residents. A total of 6,157 participants (58.6 female) completed the discrimination measure and had weight and height available from the 2006 and 2010 assessments. Participants who experienced weight discrimination were approximately 2.5 times more likely to become obese by follow-up (OR = 2.54, 95 CI = 1.58-4.08) and participants who were obese at baseline were three times more likely to remain obese at follow up (OR = 3.20, 95 CI = 2.06-4.97) than those who had not experienced such discrimination. These effects held when controlling for demographic factors (age, sex, ethnicity, education) and when baseline BMI was included as a covariate. These effects were also specific to weight discrimination; other forms of discrimination (e.g., sex, race) were unrelated to risk of obesity at follow-up. The present research demonstrates that, in addition to poorer mental health outcomes, weight discrimination has implications for obesity. Rather than motivating individuals to lose weight, weight discrimination increases risk for obesity.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Methodology; Other; Retirement Planning and Satisfaction

Physical and biological indicators of health and functioning in U.S. oldest old - Jennifer A Ailshire; Eileen M. Crimmins (Annual Review of Gerontology and Geriatrics, 2013)
This chapter examines biomarkers of aging, including indicators of physical performance and biomarkers of physiological dysregulation, among a representative national sample of U.S. adults aged 80 years and older with the aim of addressing three questions about the oldest old U.S. population: (a) How do levels of biomarkers of aging vary by age? (b) Are biomarkers of aging patterned by gender, race, ethnicity, and education? and (c) Which biomarkers of aging predict health and mortality. Data for this study come from the Health and Retirement Study (HRS). This large population-based study of U.S. adults aged 80 years and older provides confirmation of the importance of biomarkers of aging for understanding health and longevity in the oldest old. The results indicate that physical functioning declines across age groups even among the oldest old, and that the oldest adults are more likely to have levels of physical performance, inflammation, and organ function that are considered to be high risk for poor health outcomes. In addition, social disparities in physical functioning continue to be evident among the oldest segment of the U.S. population. We also provide evidence for the value of several biomarkers of aging in predicting poor health outcomes among the oldest old. In particular, indicators of high risk for walking dysfunction and dysregulation in the lungs and kidneys were found to predict hospitalization and short-term mortality.
Keywords: End of life decisions; Health Conditions and Status; Healthcare

Physical Function Limitations Among Middle-Aged and Older Adults With Prediabetes One exercise prescription may not fit all - Pearl G. Lee; Christine T Cigolle; Ha, Jinkyung; Lillian C. Min; Susan L Murphy; Caroline S Blaum; Herman, William H. (Diabetes Care, 2013)
OBJECTIVETo describe the prevalence of physical function limitations among a nationally representative sample of adults with prediabetes.RESEARCH DESIGN AND METHODSWe performed a cross-sectional analysis of 5,991 respondents 53 years of age from the 2006 wave of the Health and Retirement Study. All respondents self-reported physical function limitations and comorbidities (chronic diseases and geriatric conditions). Respondents with prediabetes reported no diabetes and had a measured glycosylated hemoglobin (HbA(1c)) of 5.7-6.4 . Descriptive analyses and logistic regressions were used to compare respondents with prediabetes versus diabetes (diabetes history or HbA(1c) 6.5 ) or normoglycemia (no diabetes history and HbA(1c) 5.7 ).RESULTSTwenty-eight percent of respondents 53 years of age had prediabetes; 32 had mobility limitations (walking several blocks and/or climbing a flight of stairs); 56 had lower-extremity limitations (getting up from a chair and/or stooping, kneeling, or crouching); and 33 had upper-extremity limitations (pushing or pulling heavy objects and/or lifting 10 lb). Respondents with diabetes had the highest prevalence of comorbidities and physical function limitations, followed by those with prediabetes, and then normoglycemia (P 0.05). Compared with respondents with normoglycemia, respondents with prediabetes had a higher odds of having functional limitations that affected mobility (odds ratio OR 1.48), the lower extremities (OR 1.35), and the upper extremities (OR 1.37) (all P 0.01). The higher odds of having lower-extremity limitations remained after adjusting for age, sex, and body mass index (OR 1.21, P 0.05).CONCLUSIONSComorbidities and physical function limitations are prevalent among middle-aged and older adults with prediabetes. Effective lifestyle interventions to prevent diabetes must accommodate physical function limitations.
Keywords: Demographics; Disabilities; Event History/Life Cycle; Health Conditions and Status; Other; Risk Taking

Physical health effects of the housing boom: quasi-experimental evidence from the health and retirement study - Hamoudi, Amar; Jennifer B Dowd (American Journal of Public Health, 2013)
Objectives. We examined the impact of the dramatic increases in housing prices in the United States in the 1990s and early 2000s on physical health outcomes among a representative sample of middle-aged and older Americans. Methods. Using a quasi-experimental design, we exploited geographic and time variation in housing prices using third-party valuation estimates of median single-family detached houses from 1988 to 2007 in each of 2400 zip codes combined with Health and Retirement Study data from 1992 to 2006 to test the impact of housing appreciation on physical health outcomes. Results. Respondents living in communities in which home values appreciated more rapidly had fewer functional limitations, performed better on interviewer-administered physical tasks, and had smaller waist circumference. Conclusions. Our results indicate that increases in housing wealth were associated with better health outcomes for homeowners in late middle age and older. The recent sharp decline in housing values for this group may likewise be expected to have important implications for health and should be examined as data become available.
Keywords: Health Conditions and Status; Healthcare; Housing

Precautionary Savings Against Health Risks: Evidence From the Health and Retirement Study - Tansel Yilmazer; Scharff, R. L. (Research on Aging, 2013)
The precautionary savings model predicts that households accumulate wealth to self-insure against unexpected declines in future income and unforeseen expenditures. The goals of this study are twofold. First, we investigate whether the near-elderly who face higher health risks save more. Second, we examine the factors that contribute to health risks that the near-elderly face. We use data from the Health and Retirement Study to construct two measures of health risks. Our results do not support the hypothesis that household savings increase with the health risks that they face. Individuals who confront higher health risks in the future are those who are already in fair or poor health status or those who have a health condition such as diabetes or lung disease. Lower earnings and high medical expenditures caused by current poor health status prevent households from accumulating savings for future health adversities.
Keywords: Consumption and Savings; Health Conditions and Status; Healthcare; Net Worth and Assets

Predicting 10-year alcohol use trajectories among men age 50 years and older - Janet Kay Bobo; April A Greek; Daniel H. Klepinger; Jerald R Herting (Am J Geriatr Psychiatry, 2013)
To describe common 10-year drinking trajectories followed by men age 50 years or older and identify risk factors for those trajectories. Longitudinal data were used to derive a semiparametric group-based model. Men from the Health and Retirement Study age 50-65 years in 1998 who completed three or more of the six interviews conducted from 1998 to 2008, including our 1998 baseline interview. Biannual data on number of drinks per drinking day were used to derive drinking trajectories. Risk factors included baseline age, race, ethnicity, education, marital status, retirement, smoking, binge drinking, vigorous exercise, body mass index, depression, pain, self-reported health, and chronic disease. The best-fitting model included consistent infrequent drinkers and nondrinkers (40.6 of cohort), increasing drinkers (5.5 ), decreasing drinkers (7.6 ), consistent at-risk drinkers (15.6 ), and consistent moderate drinkers (30.7 ). Adjusted logistic regression models comparing men with similar 1998 drinking levels who subsequently followed different trajectories identified significant risks associated with age, education, smoking, binge drinking, depression, pain, and self-reported health. To illustrate, odds ratios (ORs) and 95 confidence intervals (95 CIs) suggest that baseline infrequent drinkers were less likely to follow an increasing drinkers trajectory if they were older (OR: 0.57, 95 CI: 0.38-0.82) and smoked cigarettes (OR: 0.47, 95 CI: 0.30-0.74). Baseline drinkers were less likely to follow a decreasing trajectory if they reported more than 12 years of education (OR: 0.58, 95 CI: 0.42-0.82) and thought that their health was excellent or very good (OR: 0.54, 95 CI: 0.39-0.76). Only 30.7 of older men in this cohort were moderate drinkers throughout the follow-up. Many older men may benefit from brief counseling on the risks and benefits of drinking.
Keywords: Health Conditions and Status; Risk Taking

The predictive validity of subjective mortality expectations: evidence from the health and retirement study - Todd E. Elder (Demography, 2013)
Several recent studies suggest that individual subjective survival forecasts are powerful predictors of both mortality and behavior. Using 15 years of longitudinal data from the Health and Retirement Study, I present an alternative view. Across a wide range of ages, predictions of in-sample mortality rates based on subjective forecasts are substantially less accurate than predictions based on population life tables. Subjective forecasts also fail to capture fundamental properties of senescence, including increases in yearly mortality rates with age. To shed light on the mechanisms underlying these biases, I develop and estimate a latent-factor model of how individuals form subjective forecasts. The estimates of this model's parameters imply that these forecasts incorporate several important sources of measurement error that arguably swamp the useful information they convey.
Keywords: Expectations; Health Conditions and Status; Methodology; Retirement Planning and Satisfaction

Predictors of Smoking Patterns After First Stroke - Michael J. McCarthy; Nathalie Huguet; Jason T Newsom; Mark S Kaplan; Bentson McFarland (Social Work in Health Care, 2013)
Persistent smoking following stroke is associated with poor outcomes including development of secondary stroke and increased mortality risk. This study uses longitudinal data from the U.S. Health and Retirement Study (1992-2008) to investigate whether depression and duration of inpatient hospital care impact smoking outcomes among stroke survivors (N = 745). Longer duration of care was associated with lower likelihood of persistent smoking. Depression was associated with greater cigarette consumption. Interaction effects were also significant, indicating that for survivors who experienced longer inpatient care there was a weaker association between depression and cigarette consumption. Implications for practice and research are discussed. PUBLICATION ABSTRACT
Keywords: Health Conditions and Status; Public Policy

Is Psychological Vulnerability Related to the Experience of Fraud in Older Adults? - Peter A Lichtenberg; Stickney, Laurie; Daniel Paulson (Clinical Gerontologist, 2013)
Financial exploitation, and particularly thefts and scams, are increasing at an alarming rate. In this study we (a) determined the national prevalence of older adults who report having been a victim of fraud, (b) created a population-based model for the prediction of fraud, and (c) examined how fraud is experienced by the most psychologically vulnerable older adults. The older adults studied were 4,400 participants in a Health and Retirement Study substudy, the 2008 Leave Behind Questionnaire. The prevalence of fraud across the previous 5 years was 4.5 . Among measures collected in 2002, age, education, and depression were significant predictors of fraud. Financial satisfaction and social-needs fulfillment were measured in 2008 and were significantly related to fraud above and beyond the 2002 predictors. Using depression and social-needs fulfillment to determine the most psychologically vulnerable older adults, we found that fraud prevalence was three times higher (14 ) among those with the highest depression and the lowest social-needs fulfillment than among the rest of the sample (4.1 ; 2 = 20.49; p .001). Clinical gerontologists and other professionals in the field need to be aware of their psychologically vulnerable clients' heightened exposure to financial fraud.
Keywords: Health Conditions and Status; Net Worth and Assets; Other; Public Policy

Purpose in life and reduced incidence of stroke in older adults: 'The Health and Retirement Study' - Eric S Kim; Jennifer K Sun; Nansook Park; Christopher Peterson (Journal of Psychosomatic Research, 2013)
Objective: To determine whether purpose in life is associated with reduced stroke incidence among older adults after adjusting for relevant sociodemographic, behavioral, biological, and psychosocial factors. Methods: We used prospective data from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50. 6739 adults who were stroke-free at baseline were examined. A multiple imputation technique was used to account for missing data. Purpose in life was measured using a validated adaptation of Ryff and Keyes' Scales of Psychological Well-Being. After controlling for a comprehensive list of covariates, we assessed the odds of stroke incidence over a four-year period. We used psychological and covariate data collected in 2006, along with occurrences of stroke reported in 2008, 2010, and during exit interviews. Covariates included sociodemographic factors (age, gender, race/ethnicity, marital status, education level, total wealth, functional status), health behaviors (smoking, exercise, alcohol use), biological factors (hypertension, diabetes, systolic blood pressure, diastolic blood pressure, BMI, heart disease), negative psychological factors (depression, anxiety, cynical hostility, negative affect), and positive psychological factors (optimism, positive affect, and social participation). Results: Greater baseline purpose in life was associated with a reduced likelihood of stroke during the four-year follow-up. In a model that adjusted for age, gender, race/ethnicity, marital status, education level, total wealth, and functional status, each standard deviation increase in purpose was associated with a multivariate-adjusted odds ratio of 0.78 for stroke (95 CI, 0.67-0.91, p =.002). Purpose remained significantly associated with a reduced likelihood of stroke after adjusting for several additional covariates including: health behaviors, biological factors, and psychological factors. Conclusion: Among older American adults, greater purpose in life is linked with a lower risk of stroke.
Keywords: Demographics; Health Conditions and Status; Healthcare

Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up - Eric S Kim; Jennifer K Sun; Nansook Park; Laura D Kubzansky; Christopher Peterson (Journal of Behavioral Medicine, 2013)
This study examined whether purpose in life was associated with myocardial infarction among a sample of older adults with coronary heart disease after adjusting for relevant sociodemographic, behavioral, biological, and psychological factors. Prospective data from the Health and Retirement Study--a nationally representative panel study of American adults over the age of 50--were used. Analyses were conducted on the subset of 1,546 individuals who had coronary heart disease at baseline. Greater baseline purpose in life was associated with lower odds of having a myocardial infarction during the 2-year follow-up period. On a six-point purpose in life measure, each unit increase was associated with a multivariate-adjusted odds ratio of 0.73 for myocardial infarction (95 CI, 0.57-0.93, P = .01). The association remained significant after controlling for coronary heart disease severity, self-rated health, and a comprehensive set of possible confounds. Higher purpose in life may play an important role in protecting against myocardial infarction among older American adults with coronary heart disease.
Keywords: Health Conditions and Status; Healthcare

Quantifying the Unquantifiable: The Measurement and Meanings of Chronic Pain - Grol-Prokopczyk, Hanna (The University of Wisconsin - Madison, 2013)
Chronic pain is an extremely common, costly, and consequential health problem--and one that defies easy quantification. How do (or could) health researchers define and measure this invisible, subjective, and temporally complex phenomenon? This dissertation addresses this question in three empirical chapters, each using different data sources and methods. The first empirical chapter, based on close analysis of 79 medical studies of low back pain (LBP) and 20 interviews with international pain experts, documents the diversity of pain measures used in contemporary LBP research, and seeks to understand why these measures are poorly standardized. Findings reveal several factors undermining standardization, including the locality and multiplicity of the concepts of "validity" and "comparability," as well as the loose networks of the LBP research community. In addition, some pain researchers, responding to the considerable challenges of treating pain intensity , redefine their work around other, putatively more treatable domains, such as disability or social participation. The diversity of measures of low back pain is thus attributable less to pain's epistemological fragility than to its therapeutic intractability. The next chapter uses 11-country data from the World Health Organization and the Health and Retirement Study (HRS) to test whether a recently developed survey method, anchoring vignettes, can improve intergroup comparability of self-ratings of pain. Results show that, except in rare circumstances, existing anchoring vignettes substantially violate critical measurement assumptions, and thus should not be used. The final empirical chapter highlights the dimension of time in its measurement of chronic pain, using 7 waves of biennial HRS data to identify patterns and socioeconomic disparities in long-term pain trajectories. Latent growth curve models reveal striking disparities in pain experiences by sex, education, wealth, and survival status, but a surprising lack of expected disparities by age and race-ethnicity. These findings do not appear to be artifacts of group differences in reporting styles (though they do appear to result partially from mortality selection). Overall, this dissertation integrates sociological theories, advanced statistical methods, and empirical data to explore the measurement of chronic pain, with a goal of enhancing future research on this important area of health research.
Keywords: Cross-National; Health Conditions and Status; Healthcare; Methodology; Other

The Receipt of Care and Depressive Symptoms in Later Life - Kwak, Minyoung (Social Work and Sociology, 2013)
Apace with the rapid increase in the aging population and steep reductions in federal funding for long-term care in the U.S., caregiving is emerging as an important issue for many families. Although caregiving relationships include both a caregiver and a care-recipient, existing research has focused heavily on caregivers and the experiences of care-receiving older adults have been less-well documented. This three-essay dissertation explores how the receipt of care influences depressive symptoms among older adults by analyzing nationally representative data from the Health and Retirement Study. Based on identity theory, the first essay examines the extent to which self-perceptions of aging explain the relationships among the receipt of care, perceived loss of control, and depressive symptoms among older adults. Structural equation modeling was used. Results indicated that self-perceptions of aging mediated the relationship between receipt of care and perceived loss of control as well as the relationship between receipt of care and depressive symptoms. That is, older adults who received a greater amount of care were more likely to perceive their aging negatively which, in turn, increased perceived loss of control and depressive symptoms. The second essay investigated whether older adults who receive care from their spouse are more vulnerable to the negative impact of their spouse's physical and mental health than older adults who do not receive care by using a linear mixed model. Results indicated that the receipt of care moderates only the impact of wives' mental health on husbands' depressive symptoms. Husbands who receive care from their wives are more sensitive to their wives' depressive symptoms than husbands who do not receive care. Finally, the third essay assessed to what extent the effects of positive and negative supxi port from spouses are stronger for caregiving couples than for non-caregiving couples. Structural equation modeling demonstrated that positive support from spouses is more important for wives who provide or receive care than for those in non-caregiving relationships. No differences in the effects of negative support from spouses were observed between caregiving and non-caregiving couples.
Keywords: Demographics; Health Conditions and Status; Healthcare; Other

Recession depression: Mental health effects of the 2008 stock market crash - Melissa McInerney; Jennifer M Mellor; Lauren Hersch Nicholas (Journal of Health Economics, 2013)
Do sudden, large wealth losses affect mental health? We use exogenous variation in the interview dates of the 2008 Health and Retirement Study to assess the impact of large wealth losses on mental health among older U.S. adults. We compare cross-wave changes in wealth and mental health for respondents interviewed before and after the October 2008 stock market crash. We find that the crash reduced wealth and increased feelings of depression and use of antidepressant drugs, and that these effects were largest among respondents with high levels of stock holdings prior to the crash. These results suggest that sudden wealth losses cause immediate declines,in subjective measures of mental health. However, we find no evidence that wealth losses lead to increases in clinically-validated measures of depressive symptoms or indicators of depression.
Keywords: Event History/Life Cycle; Health Conditions and Status; Income; Net Worth and Assets

Reciprocity Between Depressive Symptoms and Physical Limitations Pre- and Postretirement: Exploring Racial Differences - Gayman, Mathew D.; Pai, Manacy; Ben Lennox Kail; Miles G Taylor (Journal of Aging and Health, 2013)
This study assesses (a) the reciprocity between mental and physical health pre- and postretirement, and (b) the extent to which these associations vary by race. Data are from the 1994 to 2008 waves of the Health and Retirement Study. Analyses based on structural equation modeling reveal that depression and physical health exert reciprocal effects for Whites pre- and postretirement. For Blacks preretirement, physical limitations predict changes in depression but there is no evidence of the reverse association. Further, the association between physical limitations and changes in depressive symptoms among Blacks is no longer significant after retirement. The transition into retirement alleviates the translation of physical limitations into depressive symptoms for Blacks only. The findings underscore the relevance of retirement for reciprocity between mental and physical health and suggest that the health implications associated with this life course transition vary by race.
Keywords: Demographics; Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

Re-examining ethnic differences in concerns, knowledge, and beliefs about Alzheimer's disease: results from a national sample - Liat Ayalon (International Journal of Geriatric Psychiatry, 2013)
ObjectiveThis study aims to evaluate ethnic group differences in concerns, knowledge, and beliefs about Alzheimer's disease (AD) in three ethnic groups of older adults (White, Latino, and Black). MethodsThe Health and Retirement Study is a US national representative study of older adults over the age of 50years and their spouse of any age. The study is based on the 2010 wave. ResultsAnalysis is based on data from 939 White, 120 Latino, and 171 Black respondents who completed a special module about AD concerns, knowledge, and beliefs. There were significant ethnic differences on 7 of 13 items. However, after the adjustment for education, gender, age, having a family member with AD, depressive symptoms, and medical comorbidity, only four items showed significant ethnic group differences; relative to White respondents, Black respondents were less likely to report that having a parent or a sibling with AD increases the chance of developing AD and that genetics was an important risk for AD. In addition, relative to White respondents, both Black and Latino respondents were more likely to perceive stress as a potential risk for AD. Latino respondents were less likely to perceive mental activity as a protective factor. ConclusionsThe study found limited ethnic group differences, with most items showing a similar pattern across groups. Nevertheless, the nature of the ethnic group differences found might be associated with a differential pattern of health service use. Copyright (c) 2013 John Wiley and Sons, Ltd.
Keywords: Adult children; Demographics; Health Conditions and Status; Other

Religiousness, Physical Activity and Obesity among Older Cancer Survivors: Results from the Health and Retirement Study 2000-2010 - Nathenson, Sophia Lyn (International Journal of Religion and Spirituality in Society, 2013)
The health behaviors of cancer survivors are an important research agenda in light of mounting evidence that aspects of health such as diet and exercise have salutary effects both mentally and physically for cancer survivors, a rapidly growing population in the United States and elsewhere. This paper analyzes data from the Health and Retirement Study 2000-2010 to determine if religious salience impacts the likelihood of obesity, changes in body mass index, and weekly vigorous activity. Two theories propose different hypotheses about the relationship. The health belief model would suggest the more religious may have the perception that healthy behaviors are positive and will be more likely to have a healthy body weight and get exercise. Conversely, high religious salience may signify a God locus of health control, leading to lesser likelihood of engagement in preventive health behaviors. Using logistic and regression analysis controlling for health behaviors at baseline (2000), these theories are tested, in addition to the explanatory power of lifestyle as a potential mechanism in the relationship of religiousness to body weight. Results show that high levels of religious salience may correspond to greater likelihood of obesity and lesser likelihood of getting regular exercise. Policy implications may include a greater emphasis on diet and physical activity in religious settings that may instead stress other health behaviors such as abstinence from smoking and alcohol. ABSTRACT FROM AUTHOR
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology; Other

Repartnering Following Divorce: Implications for Older Fathers' Relations With Their Adult Children - Claire Noël-Miller (Journal of Marriage and Family, 2013)
This study examined the implications of postdivorce fathers' new unions and additional (step)children for two aspects of older fathers' relations with adult children born from a prior relationship: frequency of social contact and fathers' financial transfers. Data from multiple waves of the Health and Retirement Study (N=13,017 observations on 4,997 adult children belonging to 1,917 ever-divorced fathers) were used to estimate multilevel models. The results indicated that divorced fathers who go on to form a new union have weaker relations with adult children from a prior union than their postdivorce counterparts who remain single. This finding partly reflects the detrimental effects of repartnered older fathers' new biological children and stepchildren. There is no difference between older remarried and cohabiting fathers' intergenerational ties. Moreover, fathers' additional biological children and stepchildren have similarly negative effects on fathers' relations with adult children from a previous union.
Keywords: Adult children; Demographics; Event History/Life Cycle; Health Conditions and Status; Net Worth and Assets

A Review of Longitudinal Datasets on Ageing - Kaiser, Angelika (Journal of Population Ageing, 2013)
Issue Title: Special Issue: Longitudinal Cohort Data The growth in longitudinal datasets on ageing have resulted from a recent global initiative, in a large part encouraged and partially funded by the NIA, over the past 20 years in numerous countries eager to understand the complexities of their ageing societies. In the main these studies aim to collect data on population ageing in terms of social, medical and environmental factors. Accordingly the studies being compared in this review focus primarily on health, wellbeing and social issues. These studies have made it possible to measure, evaluate and understand a wide variety of determinants of population change and helped to identify the challenges faced on many levels for the twenty first century and beyond. They have enabled organisations, health care service providers and government more readily able to anticipate and be responsive to the need of the dynamics of the population change as not only the population rapidly increases but faces a significant rise in the percentage of elderly persons. This review looks at the aim of each study, comparisons in methodology, key policy themes, benefits, collaborations with other datasets, gaps and challenges and key findings to date. For further information, an appendix is attached with the contact details of the Principal investigator and study website. PUBLICATION ABSTRACT
Keywords: Demographics; Health Conditions and Status; Methodology

Rising Demand for Long-Term Services and Supports for Elderly People - United States Congressional Office (Washington, DC, 2013)
By 2050, one-fifth of the total U.S. population will be elderly (that is, 65 or older), up from 12 percent in 2000 and 8 percent in 1950. The number of people age 85 or older will grow the fastest over the next few decades, constituting 4 percent of the population by 2050, or 10 times its share in 1950. That growth in the elderly population will bring a corresponding surge in the number of elderly people with functional and cognitive limitations. Functional limitations are physical problems that limit a person s ability to perform routine daily activities, such as eating, bathing, dressing, paying bills, and preparing meals. Cognitive limitations are losses in mental acuity that may also restrict a person s ability to perform such activities. On average, about one-third of people age 65 or older report functional limitations of one kind or another; among people age 85 or older, about two-thirds report functional limitations. One study estimates that more than two-thirds of 65-year-olds will need assistance to deal with a loss in functioning at some point during their remaining years of life.3 If those rates of prevalence continue, the number of elderly people with functional or cognitive limitations, and thus the need for assistance, will increase sharply in coming decades.
Keywords: Health Conditions and Status; Healthcare; Methodology; Public Policy

Rural African American grandmothers raising grandchildren: The impact of chronic illness - Woods, Tamara M. (Capella University, 2013)
The purpose of this qualitative phenomenological study was to explore the experiences of eight African American grandmothers residing in rural North Carolina caring for their grandchildren, while suffering from chronic health issues. The research questions for this study are as follows: (1. What is the perceived impact of chronic health issues on African American grandmothers raising their grandchildren in rural North Carolina? (2. How do grandmothers who reside in rural communities describe how their health issues have impacted their ability to care for their grandchild? (3. Do perceptions of social support and life transitions impact grandmother's health? The research examined the health, physical functioning, well-being, social support, and resources of these grandmothers. Family development theory and Wellness theory formed the theoretical frameworks for understanding the impact of the health issues on these grandmothers. The grandmothers reported challenges and needs which included their own health issues, financial difficulties, limited support, transportation difficulties, and childcare concerns. A major finding was that the grandmother's health did not negatively impact their ability to care for their grandchildren. Developing health education programs and other formal supports which focus on the health of the grandmothers, their financial difficulties, transportation needs, respite, and childcare may help address grandmother's perceptions of their changing health and level of community and social support.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Methodology; Women and Minorities

Self-employment and Health: Barriers or Benefits? - Cornelius A Rietveld; van Kippersluis, Hans; A. Roy Thurik (Rotterdam, Erasmus School of Economics (ESE), Tinbergen Institute, 2013)
The self-employed are often reported to be healthier than wage workers; however, the cause of this health difference is largely unknown. The longitudinal nature of the US Health and Retirement Study allows us to gauge the plausibility of two competing explanations for this difference: a contextual, causal effect of self-employment on health (benefit effect), or a health-related selection of individuals into self-employment (barrier effect). Our main finding is that the selection of comparatively healthier individuals into self-employment accounts for the positive cross-sectional difference. The results rule out a positive contextual effect of self-employment on health, and we present tentative evidence that, if anything, engaging in self-employment is bad for one's health. Given the importance of the self-employed in the economy, these findings contribute to our understanding of the vitality of the labor force.
Keywords: Employment and Labor Force; Health Conditions and Status; Healthcare

Is Self-Rated Health Comparable Between Non-Hispanic Whites and Hispanics? Evidence From the Health and Retirement Study - Su, Dejun; Wen, Ming; Kyriakos S Markides (The Journals of Gerontology, 2013)
Using subsequent all-cause mortality as a yardstick for retrospective health, this study assessed the comparability of self-rated health (SRH) between non-Hispanic whites and Hispanics. Based on longitudinal data from 6,870 white and 886 Hispanic respondents aged between 51 and 61 in the 1992 Health and Retirement Study, we related SRH in 1992 to risk of mortality in the 1992-2008 period. Logit models were used to predict white-Hispanic differences in reporting fair or poor SRH. Survival curves and cox proportional hazard models were estimated to assess whether and the extent to which the SRH-mortality association differs between non-Hispanic whites and Hispanics. Hispanic respondents reported worse SRH than whites at the baseline, yet they had similar risk of mortality as whites in the 1992-2008 period. Overall, Hispanics rated their health more pessimistically than whites. This was especially the case for Hispanics who rated their health fair or poor at the baseline, whereas their presumed health conditions, as reflected by subsequent risk of mortality, should be considerably better than their white counterparts. Health disparities between whites and Hispanics aged between 51 and 61 will be overestimated if the assessment has been solely based on differences in SRH between the two groups. Findings from this study call for caution in relying on SRH to quantify and explain health disparities between non-Hispanic whites and Hispanics in the United States.
Keywords: Demographics; Health Conditions and Status; Methodology; Retirement Planning and Satisfaction; Women and Minorities

Sense of Control and Self-Reported Health in a Population-Based Sample of Older Americans: Assessment of Potential Confounding by Affect, Personality, and Social Support - Ward, Michael M. (International Journal of Behavioral Medicine, 2013)
Sense of control has been linked to improved health outcomes, but it is unclear if this association is independent of other psychosocial factors. The aim of this study is to test the strength of association between sense of control and self-reported health after adjustment for positive and negative affect, Big 5 personality factors, and social support. Data on sense of control (measured by personal mastery, perceived constraints, and a health-specific rating of control), affect, personality, social support, and two measures of self-reported health (global rating of fair or poor health and presence of functional limitations) were obtained on 6,891 participants in the Health and Retirement Study, a population-based survey of older Americans. The cross-sectional association between sense of control measures and each measure of self-reported health was tested in hierarchical logistic regression models, before and after adjustment for affect, personality, and social support. Participants with higher personal mastery were less likely to report fair/poor health (odds ratio 0.76 per 1-point increase) while those with higher perceived constraints were more likely to report fair/poor health (odds ratio 1.37 per 1-point increase). Associations remained after adjustment for affect, but adjustment for affect attenuated the association of personal mastery by 37 and of perceived constraints by 67 . Further adjustment for personality and social support did not alter the strength of association. Findings were similar for the health-specific rating of control, and for associations with functional limitations. Sense of control is associated with self-reported health in older Americans, but this association is partly confounded by affect.
Keywords: Adult children; Health Conditions and Status; Healthcare; Methodology; Other

Social Engagement and Physical and Cognitive Health Among American Indian Participants in the Health and Retirement Study - Nelson, Lonnie A.; Carolyn Noonan; Goldberg, Jack; Dedra S. Buchwald (Journal of Cross-Cultural Gerontology, 2013)
Social engagement has many demonstrated benefits for aging non-Hispanic Whites in the U.S. This study examined data from the U.S. Health and Retirement Study to determine whether these benefits were similar among American Indians and Alaska Natives older than 50 years. Linear regression techniques were used to examine the associations between level of social engagement, scores for memory and mental status, and self-reported health among 203 American Indian and Alaska Native elders who participated in the Health and Retirement Study and had data available between 1998 and 2010. Level of social engagement was significantly associated with memory, mental status, and self-reported health. However, only the association of social engagement with mental status and self-reported health remained significant (p = 0.04 and p = 0.05, respectively) after adjusting for sociodemographic variables, number of known health conditions, and scores on the Center for Epidemiologic Studies Depression scale. Level of social engagement was not associated with patterns of decline across time in cognitive or physical health. Higher levels of social engagement are associated with better physical and cognitive functioning in American Indian and Alaska Native elders. Future studies should examine whether this association acts through cognitive stimulation, increase in physical activity resulting from social engagement, or access to resources that support physical and cognitive health.
Keywords: Health Conditions and Status; Public Policy; Women and Minorities

Social position and chronic conditions across the life span and risk of stroke: a life course epidemiological analysis of 22 847 American adults in ages over 50 - Liu, Longjian; Xue, Fuzhong; Ma, Jixiang; Ma, Marshal; Long, Yong; Newschaffer, Craig J. (International Journal of Stroke, 2013)
Background Evidence is limited on the impact of childhood socioeconomic status, adulthood socioeconomic status and chronic conditions on risk of incident stroke in later life. We aimed to examine these associations using data from a nationally representative sample of the Health and Retirement Study. Methods Stroke-free participants (n=22847) aged 50 years in the Health and Retirement Study (1992-2008) were analyzed. Childhood and adulthood socioeconomic status were assessed using parental and participant's education attainments. Incident stroke was defined as self-reported first incident stroke. Results Of the study sample, 2298 subjects experienced first incident stroke (1006 ). Cox's regression models indicate that subjects with low childhood socioeconomic status had 136 times higher risk (95 confidence interval: 118-157) of first incident stroke than those with high childhood socioeconomic status. There was an 8 reduction of this association after adjustment for adulthood socioeconomic status. Adults with diabetes mellitus had the highest hazard ratio (191, 95 confidence interval: 163-223) for incident stroke, followed by heart disease (169, 148-193), and then hypertension (156, 140-175). Significant interaction effect of childhood socioeconomic status and diabetes mellitus, and combined effects of socioeconomic status and chronic conditions on risk of incident stroke were observed. Conclusions Both low socioeconomic status in childhood and adulthood socioeconomic status predict the risk of stroke. There are significantly combined effects of socioeconomic status and chronic conditions on the risk of stroke. Improving socioeconomic status across the life span and aggressive control of chronic conditions may play pivotal roles in the prevention of stroke development.
Keywords: Employment and Labor Force; Health Conditions and Status

Social relationships and dental care service utilization among older adults - Jeffrey A Burr; Lee, Hyo Jung (Journal of Aging and Health, 2013)
This study described the association between dental care service utilization and two domains of social relationships (social integration and social support) among older adults. The study employed data from the 2008 Health and Retirement Study, examining regression models for whether a person visited a dentist in the past 2 years, including adjustments for demographic, socioeconomic, and health characteristics. Social interaction, social participation, neighborhood cohesion, and marital status were related to an increased likelihood of having visited a dentist. Older persons exhibiting loneliness and having received financial aid from network members demonstrated a decreased likelihood of visiting a dentist. The increased likelihood of visiting a dentist when a child lives nearby only occurred after introducing health covariates. The article discusses the implications of the study findings as they relate to social relationships and oral health and recommends some additional research directions to explore the etiology of dental care use.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Methodology

Socioeconomic Status and Health Well-Being during Later Life: Potential Mediating Factors - Hsu, Tze-Li; Cossman, Jeralynn S. (Sociological Spectrum, 2013)
This study explores the socioeconomic status (SES)-perceived health association, with special attention on living arrangements. It improves upon existing explanations of causal mechanisms underlying the impact of SES on health among the elderly. Using Health and Retirement Study to run ordered logistic regression, it addresses the importance of living arrangements for self-reported health. Income and education are both important predictors of self-reported health and that after controlling them, living arrangements also affect self-reported health. Future research should highlight nuanced measures of living arrangements and should explore longitudinal analyses to determine the long-term effects of these factors on self-reported health.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction

Spousal Effects in Smoking Cessation: Matching, Learning, or Bargaining? - McGeary, Kerry Anne (NBER Working Paper, 2013)
Previous research studying the correlation in smoking behavior between spouses has discounted the role of bargaining or learning. Using the Health and Retirement Study (HRS), which contains information on smoking cessation and spouse s preferences, this paper presents an essential investigation of the importance of spousal bargaining or learning on the decision to cease smoking. We find, regardless of gender, when one member of couple ceases smoking this induces the other member to cease smoking through bargaining. Further, we find females demonstrate either altruistic behavior toward a spouse, who has suffered a health shock, or learning from their spouse s health shock.
Keywords: Health Conditions and Status; Healthcare; Methodology; Other; Risk Taking

A taxa de atividade economica e saude mental: a relacao entre aposentadoria e depressao - Terra, Luisa Pimenta; Queiroz, Bernardo Lanza (Revista Debate Econ mico, 2013)
As ltimas d cadas observaram um crescimento acelerado de transtornos mentais na sociedade, com cerca de 450 milh es de pessoas com esse diagn stico no mundo. O alto custo para o sistema de sa de e para a qualidade de vida das pessoas refor a a discuss o do tema como uma quest o de sa de p blica. H uma ampla discuss o sobre o efeito da depress o na decis o de sa da do mercado de trabalho das pessoas mais idosas. Entretanto, h resultados recentes que apontam o aumento do n mero de aposentadorias precoces em diversos pa ses. O objetivo deste trabalho investigar qual a rela o entre a rec m-aposentadoria e a depress o em mulheres norte-americanas. Dados longitudinais do Health and Retirement Study entre 1992 e 2004 s o utilizados. A hip tese central que ser rec m-aposentada tem rela o negativa com o quadro de depress o, e baseada na ideia da intera o social como um agente protetor da depress o. Os resultados mostram que aposentar tem forte rela o com depress o. Mulheres rec m-aposentadas apresentam pior quadro de depress o do que as mulheres n o aposentadas e do que as que j est o aposentadas h mais de um ano. The last decades have observed a rapid increase of mental disorders in society, with about 450 million people with this diagnosis in the world. The high cost to the health system and the quality of life reinforces the discussion of the issue as a public health issue. There is an extensive discussion on the effect of depression in the decision to leave the labor market for older people. However, recent results indicate that the increase in the number of early retirement in many countries. The objective of this study is to investigate the relation between the newly-retirement and depression in U.S. women. Longitudinal data from the Health and Retirement Study between 1992 and 2004 are used. The central hypothesis is that being newly retired is negatively related to depressive states, and is based on the idea of social interaction as a protective agent of depression. The results show that retirement is strongly related to depression. Newly retired women have a worse picture of depression than women not retired and those who are already retired for over a year.
Keywords: Demographics; Health Conditions and Status; Retirement Planning and Satisfaction

Three Essays in Applied Microeconomics - Zhang, Xuelian (Economics, 2013)
This dissertation contains three chapters in applied microeconomics. All three chapters try to answer one question: what factors determine labor market outcomes like employment probability, occupational choice and earnings? Chapter 1 investigates the effects of multidimensional personality traits on employment status, occupational choice and earnings. Using the United Kingdom National Child Development Study, the analysis deals with the problems of reverse causality and measurement error by instrumental variable methods. The results indicate that personality traits play an important role in explaining the variation in labor market outcomes. The more agreeable and conscientious, and the less imaginative a person is, the more likely he is employed. The more outgoing and the less imaginative a person is, the more likely he works in a managerial occupation, but the less likely in a non-manual occupation. Agreeableness reduces one's probability of being in a professional occupation. Being outgoing and conscientious leads to higher earnings for paid employees. Chapter 2 uses the United States Health and Retirement Study to study the effects of elder care provision on one's job choice with respect to flexibility. Fixed effects panel data models are used to control for time-invariant individual heterogeneity. Compared to non-caregivers, both male and female caregivers are significantly more likely to sort into flexible jobs or occupations, though they realize job flexibility through different channels: caregiving women are more likely to choose jobs with direct flexible work arrangements like flexible schedules, while caregiving men are more likely to realize flexibility indirectly by sorting into flexible occupation categories. Chapter 3 uses the Brazil Living Standards Measurement Study Survey to examine the long-run consequences of child labor on an adult's income, health and educational attainment. The analysis leads to the following conclusions. Early working has a substantial negative impact on earnings for rural residents but no impact on urban residents. For health, child labor has an adverse consequence in the long run. As for the schooling effect, the earlier one enters the labor market, the fewer years of schooling he obtains. I also discover appreciable differences of child labor effects between urban and rural residents.
Keywords: Adult children; Employment and Labor Force; Health Conditions and Status; Healthcare; Methodology

Three essays in public economics - Anderson, Michael Throan (The University of Wisconsin - Madison, 2013)
The first and second chapters of this dissertation consider household financial decision making. In the first chapter I examine the phenomenon of early claiming for Social Security retirement benefits. Previous work has shown that early claiming, in particular by the primary earner in married couples, is not consistent with household benefit maximization nor is it predicted by models of utility maximization. I show that observed claiming behavior is explained well by a model in which the primary earner chooses when to claim without taking into consideration the effect of the choice on the secondary earner's spousal and survivor benefits. I find that the decrease in the value of household benefits due to early claiming is borne almost entirely by the surviving spouse. In the second chapter, with John Karl Scholz and Ananth Seshadri, we use the insight of a lifecycle model to better understand the factors that affect household retirement savings targets. Two of the most important determinants of savings targets are households' location in the lifetime income distribution and number of children. We measure the deviation of a set of financial guidelines for retirement saving from the optimal asset accumulation implied by the lifecycle model and suggest an alternate savings heuristic that takes into account insights from the lifecycle model. The third chapter applies a novel estimation strategy to measure the benefit of hazardous waste site remediation. In contrast to previous estimates, this method calculates the benefit of site remediation allowing for diminishing marginal utility. Using data on home sales in Cincinnati, Ohio in 2000 I find the median willingness to pay for a one mile increase to the nearest hazardous waste site is $228 per year. This is lower than previous estimates which range from $284 to $1,065 per year.
Keywords: Health Conditions and Status; Methodology; Net Worth and Assets; Other; Public Policy; Social Security

Vascular depression: An early indicator of decline - Daniel Paulson (Psychology, 2013)
Women over the age of 80 represent a rapidly growing demographic group. While older women live longer than men, they do so with more years of disability and frailty. The emergence of geriatric disorders such as vascular disease, depression, frailty and cognitive decline in the aging US population place additional strain and expense on the already over-burdened public health care system. Meanwhile, integrated models of care are associated with preserved functional independence, reduced medical costs, and greater satisfaction for both health care providers and patients. Implementation of integrated care demands process-models of disease that contextualize symptoms within broader patterns of decline. This dissertation proposes a model representing a hypothesized late-life clinical trajectory following from high cerebrovascular burden. The hypothesized trajectory includes higher rates of depression (of vascular origin), cognitive decline, frailty and shortened remaining lifespan. Different facets of this model are tested in the four studies that comprise this dissertation. The sample was drawn from the Health and Retirement Study; a longitudinal, demographically-representative data sample of older adults in the United States. The sub-sample used in this dissertation included 1,368 stroke-free women over the age of 80 at baseline (1998). This sub-sample was followed for 10 years. The first study tested the hypotheses that high CVB predicts greater depression symptoms, and that brain reserve (i.e.: education) protects elders from developing depression symptoms. A latent growth curve was used to identify differences in depression at baseline and over time based on CVB, cognitive functioning, education and age. Results indicate that at any level of CVB, older women with more education experienced fewer depression symptoms. Results support brain reserve theory and the vascular depression hypothesis. These results suggest that having greater education may postpone development of clinically-significant depressive symptoms resulting from high CVB, thereby preserving mood in late life. The second study tested the hypothesis that variables representing the three domains of Rowe and Kahn's Healthy Aging framework predict longevity in this sample of stroke-free women over the age of 80. The "avoidance of disease" domain was characterized in this paper as CVB - chronic comorbidites that slowly erode adaptive functioning over many years. The "sustained engagement" criteria was conceptualized as depression, and deficits in the "preservation of cognitive and physical functioning" domain were identified as rapid cognitive decline. We found that at most waves (2002, 2004, 2006) mortality was predicted by CVB, depressive symptoms and cognitive drop measured 2 years prior. CVB and depressive symptoms at the 2000 wave predicted mortality at 6 and 8-years. Older women with the greatest longevity had low CVB, robust cognitive functioning and few depression symptoms, supporting successful aging theory and terminal cognitive drop. The third study tested the hypothesis that vascular depression is a prodrome for frailty. At baseline, the prevalence of frailty was 31.5%. Over a 4-years the incidence of frailty was 31.8%. After controlling for age, education, ADL and IADL functioning, arthritis, pulmonary disorders, cancer, and self-rated health, vascular depression significantly predicted new cases of frailty. These findings suggest that vascular depression is a prodrome for frailty. The fourth study tested the proposed model using structural modeling. The model demonstrated good overall fit and a significant indirect pathway from vascular depression to mortality through frailty was identified. Results support the proposed theoretical framework and suggest that vascular depression symptoms are associated with a clinical trajectory including more frailty symptoms and shorted remaining lifespan. This finding supports integrated care for geriatric p tients and suggests specific targets for intervention with older patients experiencing vascular depressi n symptoms.
Keywords: Health Conditions and Status; Healthcare; Women and Minorities

Volunteering among surviving spouses: The impact of volunteer activity on the health of the recently widowed - Kimberly J. Johnson (Gerontology, 2013)
Numerous studies link volunteering to positive mental and physical health for older adults, and recent studies have suggested that volunteering may be particularly beneficial for those who are widowed. This research examines the potential of volunteering to buffer participants from stress-related health declines associated with the death of a spouse. Using the Health and Retirement Study (HRS), this research investigates the moderating role of volunteering on the self-rated health and depressive symptoms of recently widowed older adults. Consecutive waves of the HRS are used to identify respondents who experience the death of a spouse or who remain married, and those married or widowed respondents who participate in volunteer work over a two-year period. Waves 1998 through 2004 are used to construct three observation periods: 1998-2000, 2000-2002, and 2002-2004. A series of logistic and negative binomial regression analyses are used to estimate the direct effect and interactive effect of widowed status and volunteer status on self-rated health and depressive symptoms respectively. Results indicate that while volunteering decreases the odds of being in fair or poor health and decreases the expected number of depressive symptoms for volunteers compared with nonvolunteers, volunteering does not buffer recent widows from declines in self-rated health or reduce the risk of more depressive symptoms. The results do not support the idea that volunteering serves as a source of social support for older adults when dealing with the stress of spousal loss. However, the findings do support the idea that participating in volunteering helps older adults remain socially integrated through a meaningful role in their community.
Keywords: Adult children; Health Conditions and Status; Healthcare; Methodology; Net Worth and Assets

What Good Is Wealth Without Health? The Effect Of Health On The Marginal Utility Of Consumption - Finkelstein, Amy; Erzo F. P. Luttmer; Matthew J Notowidigdo (Journal of the European Economic Association, 2013)
We estimate how the marginal utility of consumption varies with health. To do so, we develop a simple model in which the impact of health on the marginal utility of consumption can be estimated from data on permanent income, health, and utility proxies. We estimate the model using the Health and Retirement Study's panel data on the elderly and near-elderly, and proxy for utility with measures of subjective well-being. Across a wide range of alternative specifications and assumptions, we find that the marginal utility of consumption declines as health deteriorates, and we are able to clearly reject the null of no state dependence. Our point estimates indicate that a one-standard-deviation increase in the number of chronic diseases is associated with a 10 -25 decline in the marginal utility of consumption relative to this marginal utility when the individual has no chronic diseases. We present some simple, illustrative calibration results that suggest that state dependence of the magnitude we estimate can have a substantial effect on important economic problems such as the optimal level of health insurance benefits and the optimal level of life-cycle savings.
Keywords: Consumption and Savings; Demographics; Expectations; Health Conditions and Status; Medicare/Medicaid/Health Insurance; Methodology

Why are the oldest old less generous? Explanations for the unexpected age-related drop in charitable giving - Wiepking, Pamala; Russell N. James III (Ageing and Society, 2013)
Previous research has demonstrated that the generally positive relationship between age and the presence of charitable giving becomes negative at the oldest ages. We investigate potential causes of this drop in charitable giving among the oldest old including changes in health, cognition, egocentric networks, religious attendance, and substitution of charitable bequest planning. A longitudinal analysis of data from the United States Health and Retirement Survey indicates that the drop in charitable giving is mediated largely by changes in the frequency of church attendance, with only modest influences from changes in health and cognition.
Keywords: Adult children; Demographics; Health Conditions and Status

An analysis of well-being in retirement: The role of pensions, health, and 'voluntariness' of retirement - Bender, Keith A. (The Journal of Socio-Economics, 2012)
This paper examines a wide range of determinants of retiree well-being of retirees. Using data from the 2000 Health and Retirement Study, increases in economic factors such as income lead to higher well-being, although relative income has a larger effect than absolute income. The strongest predictors are the voluntariness of entering retirement, pension characteristics, and health. Retirees forced to retire or have defined contribution pensions or bad health have significantly lower well-being. The results suggest a more nuanced approach in addressing retiree well-being than just a focus on the economic well-being of retirees. PUBLICATION ABSTRACT
Keywords: Demographics; Employment and Labor Force; Expectations; Health Conditions and Status; Pensions

Comparing Health and Employment in England and the United States - Lain, David (Work, Health and Well-Being: The Challenges of Managing Health at Work, 2012)
This chapter explores how health influences employment past age 65 in the United States and England. This is of policy interest, because England followed the United States by extending age-discrimination legislation above 65 in 2011. Drawing conclusions about the health-related capacity of this age group to work is, however, a challenge. Common health measures are often problematic for use with older workers, particularly when they are used to make comparisons between countries. Nevertheless, the most appropriate health measures are identified from the English Longitudinal Study of Ageing and the US Health and Retirement Study. The survey analysis presented shows that, in both countries, health limitations had the strongest negative impact on employment for the poorest over-65s. This suggests that the financial benefits of working are likely to be limited for the over-65s most in need of additional income.
Keywords: Cross-National; Employment and Labor Force; Health Conditions and Status; Healthcare; Income

Consequences of Government Provision and Regulation of Health Insurance - Andersen, Martin Sparre (Harvard University, 2012)
The first two chapters of this dissertation concern the effect of public catastrophic insurance programs. In the first chapter, I show how these programs, which only protect against large health shocks, induce advantageous selection in private insurance. I use data on older Americans with Medicare insurance from the Health and Retirement Study to test if individuals with supplemental private health insurance are systematically lower-risk in states with public catastrophic insurance programs. I find that these programs decrease the average health risk for the privately insured by $700 and that a one standard deviation increase in an individual's health risk decreases her probability of having private insurance by 4 percentage points. In the second chapter, I show that these programs reduce the incentive to invest in risk-reducing activities. I find large decreases in self-protection after a program is introduced and that individuals for whom the program is less generous are more likely to engage in self-protection. These effects are stronger for women than for men and apply to a variety of investments in health, including decisions about smoking, obesity, and cancer screening. The third chapter considers a different form of government intervention in insurance markets. In this chapter, I study laws mandating that employer-sponsored health insurance provide coverage for mental illness. I show that industries for which mental health coverage became more generous had larger increases in the average mental distress of their insured workforce. Part of the increase in generosity was due to regulations mandating coverage of mental health benefits. I then show that these regulations affected the behavior of individuals in the labor market--individuals who value more generous mental health benefits and switch jobs work longer hours after these regulations take effect, but individuals who do not value mental health benefits decrease their labor supply. These results are consistent with firms cutting back on their demand for labor due to the cost of the mandate, which leads to lower wages and a decrease in labor supply by individuals who do not value mental health benefits, but an increase in labor supply by individuals who do value mental health benefits highly.
Keywords: Health Conditions and Status; Healthcare; Insurance; Medicare/Medicaid/Health Insurance; Other; Public Policy

Cross-national insights into the relationship between wealth and wellbeing: a comparison between Australia, the United States of America and South Korea - Kim, Sarang; K. A. Sargent-Cox; D. J. French; Kendig, H.; Kaarin J. Anstey (Ageing and Society, 2012)
ABSTRACT The positive relationship between wealth and wellbeing has received considerable attention over the last three decades. However, little is known about how the significance of wealth for the health and wellbeing of older adults may vary across societies. Furthermore, researchers tend to focus mainly on income rather than other aspects of financial resources even though older adults often rely on fixed income, particularly after retirement. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey (N=1,431), the Health and Retirement Study (HRS) in the United States of America (USA; N=4,687), and the Korean Longitudinal Study of Ageing (KLoSA; N=5,447), this exploratory cross-national study examined the relationship between wealth satisfaction and objective wealth and wellbeing (measured as self-rated health and life satisfaction) among older Australians, Americans and Koreans (50 years). Regression analyses showed that wealth satisfaction was associated with wellbeing over and above monetary wealth in all three countries. The relationship between monetary wealth and self-rated health was larger for the US than Australian and Korean samples, while the additional contribution of wealth satisfaction to life satisfaction was larger for the Korean than the Australian and US samples. These findings are discussed in terms of the cultural and economic differences between these countries, particularly as they affect older persons. PUBLICATION ABSTRACT
Keywords: Demographics; Health Conditions and Status; Healthcare; KLoSA; Methodology; Net Worth and Assets

Determinants of the retirement assets and the amount in stock within retirement assets: Evidence from the Survey of Consumer Finances and the Health and Retirement Study - Ting-Ying Yang; Feinberg, Richard A. (Purdue University, 2012)
The purpose of this research was to investigate the determinants of the retirement assets held in Individual Retirement Accounts, Keogh accounts, and current and future pensions. A second purpose was to investigate the determinants of the amount in stock within those retirement assets. Building upon the theory of human capital, the theory of planned behavior, and the bargaining power model, this study proposed that human capital, attitudes related to finances, and the relative bargaining power of the spouse would influence an individual's retirement assets and the amount in stocks within the retirement assets. Using data from the Survey of Consumer Finances, Study 1 explored the relationship between the three proposed domains and the amount in retirement assets and the amount in stock within the retirement assets. In Study 2, the relationship between the proposed domains was examined using similar variables but with a relatively older sample (e.g., the Health and Retirement Study). The results of both studies supported the theory of human capital and the theory of health capital. Those who had higher education and those who had better health were more likely to have more in retirement assets, and they have more in the amount of stock within retirement assets. Those who saved regularly and were more likely to take risk when saving and investing had more retirement assets and they have more in the amount of stock within retirement assets. The results on the influence of the spouse on retirement assets and the amount in stock within retirement assets showed some support for the bargaining power model. The retirement assets and the amount in stocks within retirement assets were influenced by the spouse. Age, education, working status of the spouse, and who was the more financial knowledgeable person among the two would influence the retirement assets and the amount in stock within retirement assets of the household head. The results of the study supported the existing literature on human capital and health capital. There was some support for the bargaining power model. The results suggest that educators and financial advisors should encourage couples to discuss their plans about saving for retirement with each other and their advisors. However, many people will be single during some or all of their retirement so individual plans for retirement savings should also be carefully developed. This is an important role for educators and financial advisors. However, older adults with fewer resources (e.g. education, employer-sponsored pension plans) will continue to need the support of Social Security.
Keywords: Health Conditions and Status; Methodology; Net Worth and Assets; Other; Pensions; Retirement Planning and Satisfaction

Disease as a predictor of depression in aging adults - Gray, Mikea R. (California State University, Los Angeles, 2012)
The purpose of this study is to examine the effects of self-reported chronic health conditions and functional status on the Center for Epidemiologic Studies depression scale using data from the Health and Retirement Study (HRS). The analysis consisted of fitting multivariate adaptive regression splines (MARS) modes to the extant data. Possible covariates included: age, gender, being white, being Hispanic, high blood pressure, heart disease, arthritis, lung disease, back pain, diabetes, stroke, cancer, ADL and IADL functional limitations. Data included 27,461 respondent's longitudinal data, which was collected on eight test occasions. Four hypotheses were formed. Results indicated that back pain and lung disease predicted depression scores which support the second hypothesis. ADL and IADL functional limitations were the most important predictors of depression score, confirming the third and fourth predictions. While chronic disease can lead to elevated depression scores, it appears that functional limitations may be more strongly related to depression.
Keywords: Health Conditions and Status; Healthcare; Methodology

The Effect of Long-Term Care Insurance on Home Care Use Among the Disabled Elders - Kim, So-Yun; Gong-Soog Hong; Montalto, Catherine P. (Journal of Family and Economic Issues, 2012)
Using the 1998-2004 Health and Retirement Study, this study uses Cox's model to explore the effects of private long-term care insurance ownership on first home care use among the disabled elderly. Results show that long-term care insurance ownership and Medicaid eligibility did not significantly increase the likelihood of using home care services, while income and homeownership lowered this likelihood. Functional limitation was the key determinant of home care use and those who lived with children were less likely to use home care services. Based on the findings, this study provides foundations for long-term care policies and long-term care planning programs. PUBLICATION ABSTRACT
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Public Policy

The effect of spatial access on utilization of health care services among the elderly - Lin, Chun-Lin (The University of Texas at San Antonio, 2012)
Barriers exist between potential health care users and their actual access. Compared to other age groups, the elderly population faces more spatial obstacles to health care because of diminishing mobility. The object of this dissertation is to examine the extent to which spatial factors affect utilization of health care among the elderly. This dissertation investigates the main hypothesis that seniors who live in neighborhoods with high levels of spatial access will have higher levels of health care utilization. Data from the 2008 Texas physician record were applied to construct the indicator of spatial access using the Two-Step Floating Catchment Area method. This dissertation also used the Health and Retirement Study 2008 core and 2005-2009 American Community Survey 5-year data to estimate the average level of health care utilization as a function of spatial access and other individual and contextual characteristics. Results showed that older adults who lived in a Census tract with higher spatial access actually had lower mean values of health care utilization. After adding interaction terms, however, spatial access did have positive effect on health care utilization for seniors with very good or excellent health status compared to their counterparts who had fair or poor health status. The findings suggested that spatial access did influence seniors' health care utilization, but the effects varied by an individual's health status. Future studies should control for beneficial contextual factors that might potentially offset the effect of spatial access on health care utilization.
Keywords: Health Conditions and Status; Healthcare; Methodology

Emotional distress in older adults with cancer: A multilevel longitudinal study - Tara J Schapmire (Social Work, 2012)
Data from the Health and Retirement Study (HRS) were used to examine factors that influence emotional distress in older adults with cancer, and to learn whether these distress trajectories are different from older adults without cancer. The model investigated the influence of life course factors, internal, external and health-related resources on distress over eight years among a nationally representative sample of older adults ages 50-91. Methods : This longitudinal panel study tested a multilevel random intercept multinomial ordered categorical model with a two-nested-level structure using empirical Bayes Markov chain Monte Carlo (MCMC) estimation. The model examined individual differences in distress over eight years (2000-2008), testing multiple potential predictors which were either time-variant within-person or time-invariant between-person data measured at five consecutive time periods. All those with a first diagnosis of cancer in 1998-2000 were included in study (n=200) together with a representative subsample of all noncancer cases (n=1190), for a total of 1390. Results : In each step, the model fit improved significantly using the DIC statistic. Overall, 33 percent of sample reported one or more depression symptoms in 2000, and by 2008 the number decreased to 30 percent. Keeping all main effects constant, those with cancer had one percent lower probability of depression symptoms over time than those without cancer. Significant two-way interaction effects were detected between having cancer and absence of spouse/partner in the home, and cancer and lower life expectancy; each resulted in higher probabilities of depression symptoms. A significant three-way interaction effect was detected between cancer, gender, and social support with women with a caner history and low social support having the highest probability of distress. Conclusions : Those with four or five depression symptoms at the beginning of the study tended to stay the same over time, while those with one to three symptoms tended to improve slightly. A small significant protective factor of cancer on distress over time was detected. A large protective factor of cancer existed for older adults with a partner present in the home, but cancer became a significant risk factor for distress with no partner presence. The protective factor remained for older adults with cancer and longer life expectancy, but cancer became a significant risk factor for distress low life expectancy. While there was a large protective factor of cancer among women with high social support, cancer history became a risk factor for women with low social support.
Keywords: Demographics; Health Conditions and Status; Methodology; Risk Taking

Essays in Residential Choice and Non-Market Valuation - Kuzmenko, Tatyana (Duke University, 2012)
This dissertation focuses on non-market valuation of environmental goods, using housing values and residential location decisions to infer the value of local environmental quality. It makes two contributions to the literature: First, it explores the role of expected longevity in environmental risks valuation in a framework where individuals face multiple mortality and morbidity risks. The presence of background mortality risk from the causes unrelated to pollution reduces the willingness to pay for environmental risks reduction, because the competing risk lowers the chance that the consumer will be alive to benefit from environmental quality improvements. Using data from the Health and Retirement Study, we find that individuals with shorter expected lifespan are more likely to reside near toxins-emitting facilities. The effect of the longevity expectations is significant as compared to other determinants of environmental risk exposure identified in the previous literature, such as level of education, race, and wealth. These findings imply that the expected longevity can be an important source of heterogeneity in environmental risks valuation. Second, we find evidence that owner-assessed home values "lag behind" market prices, and that this lag has the potential to substantially alter values ascribed to local amenities using property-value hedonic techniques. We hypothesize that long-standing homeowners lack an incentive to gather recent information on housing markets, and that their ignorance is reflected in the bias in their self-reported housing values. We first demonstrate that bias in self-reported home values is significantly correlated with tenure. We then examine how tenure length affects homeowners' valuation of changes in a particular local amenity--exposure to sites on the EPA's National Priorities List (i.e., the Superfund program). We find that recent movers report a value of a site's deletion from that list (signaling the end of the Superfund remediation process) that is 30-50% greater than that expressed by long-standing owners. This difference is significant and can have important implications for the results of cost-benefit analysis.
Keywords: Health Conditions and Status; Other; Public Policy

Essays on Bayesian inference of time-series and ordered panel data models - Park, Jeehyun (Rutgers The State University of New Jersey, 2012)
At the heart of my dissertation is the study of Markov chain Monte Carlo algorithms and their applications. My dissertation consists of three essays as follow. The first chapter is on MCMC algorithms for the dynamic ordered probit model with random effects. I have tried to estimate the model with four representative MCMC algorithms: two algorithms by Albert and Chib (1993) and Albert and Chib (2001), Liu and Sabatti (2000), and Chen and Dey (2000). I have found that the autocorrelations still remain high in the cutoffs compared to other parameters even though the levels of autocorrelation are reduced in the algorithms by Liu and Sabatti (2000), and Chen and Dey (2000). In the second chapter, I have developed the dynamic ordered probit model studied in the first chapter. It is natural for panel data to have missing data problem because there is no guarantee that subjects will stay over the study periods. This chapter provides Bayesian statistical methods that permit non-ignorable missing data in panel datasets. In order to incorporate non-random missing data in the model, I jointly model observed and non-ignorable missing ordinal data with selection model approach. In the empirical section, I have used the model to examine determinants of self-rated health of old people in the Health and Retirement Study. I have concluded that in this elderly American population, the longest occupation that respondents have held over their careers is strongly associated with self-rated health. In the third chapter of my dissertation, I analyze financial time-series data before and after the Wall Street meltdown in 2008. In this chapter, I develop MCMC algorithms for the CKLS model and examine (1) time-series characteristics of the credit default swap index, stock index and federal funds rate from January 2007 to September 2009, the highly volatile period. (2) The lead-lag relationship between the credit default swap and stock markets are examined using the CKLS model employing multivariate analysis.
Keywords: Health Conditions and Status; Methodology; Public Policy

Essays on family demography, household finance, and economics of the family - Fenaba R. Addo (Cornell University, 2012)
This dissertation examines the intersection of financial resources, family demography and economic well-being of American households at transitional periods in the life course. Changes in union formation, the demographic composition of the population, and family structure since the latter part of the twentieth century have challenged existing theories on household formation, individual decision-making, and economic well-being (Bumpass, 1990). With the increase in woman's labor force participation, the rise of cohabitation, pre-marital childbirth, and single-parent households, conventional models used to explain recent trends in marriage market dynamics, intra-household resource allocation, and wealth inequality are continuously tested, challenged, and revamped to keep pace with a society in a current state of demographic and economic flux. Chapter one focuses on early and young adulthood and the role of consumer and education loan debt in transitioning into coresidential relationships using a sample of youth coming of age at the turn of the twenty-first century and during a period of economic expansion, increased college enrollment and growing socioeconomic divide in marital patterns in the United States. Results suggest total debt amount is associated with cohabitation, increasing the odds of cohabitation over marriage and remaining single for both women and men. First marriage is positively associated with greater educational attainment for this cohort of young adults, but women with education loan debt are more likely to delay marrying and cohabit first. Chapter two (co-authored with Daniel T. Lichter) addresses the racial wealth gap by exploring the relationship between marriage and marital histories on wealth accumulation of older Black and White women. Marital and relationship histories are strongly associated with the wealth accumulation process. Women who marry and stay married accumulated levels of wealth that exceeded those of other women with disrupted family lives. The marriage-wealth nexus is sensitive to a women's position in the wealth distribution, and decomposition analyses highlight the non-trivial role of racial disparities in marital histories in accounting for the racial wealth gap. The third and final chapter uses seven waves of individual-level data from the Health and Retirement Survey from 1998-2008 to analyze whether there is a causal effect of being an informal basic needs or financial caregiver to an aging parent on one's health outcomes (self-assessed health and depression) and health behaviors (exercise and smoking). The results suggest a positive effect on depressive symptoms of basic needs caregiving for unmarried adult children, and that they may be selecting into that role because of their poor health. Manifestations of caregiving in future periods include, basic needs caregiving increasing the probability of smoking for married women and financial caregiving increases depressive symptoms for unmarried men. These findings suggest that the financial costs of caregiving can influence adult children's health outcomes, in particular for those not currently in a marital union.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Net Worth and Assets; Public Policy; Women and Minorities

Essays on gender and health - Medalia, Carla (University of Pennsylvania, 2012)
The relationship between gender and health is complex. Although women live longer than men in almost every country throughout the world, women also tend to be sicker than men. While biological sex differences likely contribute to sex gaps in health, cross-national, historical, and life course variation suggest that social factors also play a role. This dissertation is composed of three chapters which examine social explanations for gender gaps in mortality and morbidity. The first chapter looks at the relationship between gender equality in the public sphere, and sex gaps in life expectancy throughout the world. I find that influence of gender equality on the sex gap in life expectancy depends on the level of economic development. The second chapter takes an historical perspective to examine the trend in the sex gap in depression in the United States between 1971 and 2008. In examining this trend, I find that the sex gap in depression has decreased over the past forty years, due to a decrease in depression among women that is primarily attributable to an increase in women's labor force participation and attachment. In the third chapter, I examine the relationship between gender, aging, and depression using longitudinal data for the population over age fifty in the United States. In doing so, I find that age does not increase depression until age 75, after which point depression increases for both sexes, but particularly for men, leading to a reversal in the sex gap in depression at the end of the lifespan. Furthermore, while the majority of the age effect on depression is explained by social and health changes, I conclude that there is a net effect of age per se on depression after age 75.
Keywords: Demographics; Expectations; Health Conditions and Status; Healthcare; Methodology; Women and Minorities

Essays on human capital, expectations and behaviors - Jia, Man (Northeastern University, 2012)
Chapter 1: While previous theoretical analysis suggests that racial differences in death rates might play an important role in explaining the black-white education gap in the U.S., there is little empirical research to test this implication. This paper estimates the extent to which differences in expected mortality risks prior to entering college can explain differences in adult educational attainment in the 2000s, using data from the 1997 National Longitudinal Survey of Youth (NLSY). This study finds that the impact of mortality is not as important as suggested by prior research. Specifically, of the total black-white education gap (roughly 1.12 schooling years), only about 0.05 years or less can be attributed to differences in mortality expectations. As this study confirms, the role of self-reported mortality expectations in explaining black-white education gap is small, and the impacts of death expectations from actual death rates on education are statistically insignificant for reference groups. Chapter 2: The second chapter examines whether individuals are likely to alter personal health-related behaviors once they increase their subjective longevity expectations. To determine if there is a relationship between health behaviors and longevity beliefs, I test one of implications of the Cutler-Glaeser (2009) smoking decision model, which suggests that nonsmokers whose expected survival probabilities have increased are unlikely to start smoking. This study uses data from the Health and Retirement Study (HRS), which is conducted every two years, from 1992 to 2010 (Waves 1-10). Specifically, the HRS data show that a certain share (2.13%) of nonsmokers at Wave t-1 whose subjective expected longevity beliefs increased across two waves did start smoking at Wave t. This small percentage is close to the fraction of new smokers who have steady or decreased survival beliefs (1.99% and 2.19%, respectively). This finding also holds true for other behaviors including heavy drinking, obesity, and physical inactivity. Thus, the findings I present based on the HRS data contrasts with the Cutler-Glaeser model. Chapter 3: Using scores from the Armed Forces Qualification Test (AFQT), Herrnstein and Murray (1994) reported that intelligence can be a powerful predictor of a range of outcomes related to social behaviors (e.g., incarceration, marriage, out-of-wedlock birth, low birth weight and poverty). In contrast, a recent study found that measured intelligence using the same AFQT scores plays a considerably smaller role on an important socioeconomic indicator, namely, hourly wages as measured from 2000 to 2010. My third paper attempts to replicate the Herrnstein and Murray study using a different data set, the 1997 National Longitudinal Survey of Youth to look into several behaviorally-related social outcomes. The main finding is that, in general, the role of AFQT scores in predicting social behaviors has not substantially changed over the last 20 years. I provide a few possible explanations for this finding.
Keywords: Demographics; Expectations; Health Conditions and Status; Net Worth and Assets; Risk Taking

Essays on impact of risk preference on health and occupational choice - Beri, Meenakshi (Economics, 2012)
This dissertation re-examines Health and Retirement Study (HRS) data in order to ascertain whether there exists behavioral heterogeneity among people regarding health risk as compared to that of financial risk as well as whether there exists racial-ethnic and gender heterogeneity in the health state dependence of marginal utility. Given heterogeneous risk and time preferences of individuals, this study investigates the impact of those preferences on sorting into occupations and industries using various measures of job risk. I construct three measures of risk across jobs, cross-categorized by occupation and industry: a fatal injury rate, non-fatal injury and illness rate, and a measure of inter-person income variability. Using these measures, I analyze how risk and time preference of an individual affects his occupational choice. This study finds that there are different domains of risk and that individuals do not think of these in the same way. Using Health and Retirement Study data, I find that there exists a behavioral inconsistency in health risks versus income risk. This dissertation advises against the use of health risk proxy for making inferences about financial risk. This dissertation then examines the heterogeneity in health dependence of utility and contingent upon the findings of heterogeneity, it examines the factors contributing to utility heterogeneity. To examine this empirically, I begin with theoretical and empirical models used by Finkelstein, et al. (2011) relaxing the assumptions of those models to allow for differential effects by race, gender and ethnicity. Using happiness as a utility proxy and objective health measures in our baseline model, I find strong evidence of heterogeneity in health state dependence of utility among males and females, hispanic and non-hispanic and white, and black; not only in seven objective health conditions but also functionality limitations; not only by using happiness as a utility proxy but also with CES-D score. Since, there is slight evidence of heterogeneity in the health state dependence of utility among different health states, the policies like Medicare, and Medicaid would have varying impact on people depending upon race, ethnicity and gender. The non-linear B-O decomposition of utility unfolds that the significant contributors towards the explained gender, racial and ethnic gap in utility proxy (happiness and CES-D Score) are: marital status, number of diseases, log adjusted income, risk attitudes and ethnicity. Approximately 80 percent of the gender utility gap and 100 percent race utility gap is explained by the endowment effect. Thus, this dissertation reaffirms the findings of Halliday (2008) that there may be larger potential gains to identifying as well as targeting factors that influence individual heterogeneity since the health state dependence of utility is mostly driven by individual characteristics, as has been found to be the case in B-O decomposition of utility in the current study.
Keywords: Health Conditions and Status; Methodology; Public Policy

Financial and health security in old age: Three essays - Diebold, Jeffrey (The University of North Carolina at Chapel Hill, 2012)
This dissertation is composed of three essays that examine issues and policies related to the well-being of the elderly in the United States. Using a randomized control design, I demonstrate the relative strength of incentives structured as a credit as opposed to an economically equivalent deduction within the framework of a retirement-based annuitization decision. Next, I exploit the natural experiment provided by the establishment of Medicare Part D in 2006 to evaluate health-related outcomes affected by this policy change. I provide evidence that Medicare Part D resulted in a number of positive health-related outcomes among those Medicare beneficiaries without prescription drug coverage prior to enrolling in Part D. Finally, I test whether the financially literate are more likely to make decisions that minimize the risks to their financial security. The results from this analysis are decidedly mixed. Financially literate individuals do not, necessarily make better financial and investment related decisions but appear more active in the decision-making process.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Net Worth and Assets; Public Policy; Retirement Planning and Satisfaction

A functional use of response time data in cognitive assessment - John J. Prindle (University of Southern California, 2012)
The stimulus for the current body of work comes from the desire of researchers to have concise and accurate cognitive tasks implemented in their surveys. The main purpose of this work was to introduce collateral information as a way of making up for lost or forgone information when adaptive frameworks are adopted. The nature of ongoing surveys and the ubiquity of computers provides ample collateral, or nonintrusive, information which can help improve score accuracy. Information such as how long a respondent spends on certain items, their age, education, and other characteristics can improve score prediction beyond simple item responses. The importance of this work included methods to effectively decrease the number of items given to participants, as well as keep the accuracy high despite the loss in information. In the current study, the Woodcock Johnson - III (WJ-III) Number Series (NS) task was presented with 30 previously unpublished items as stimuli. First, a couple of scoring models were implemented to test for model fit and compare the implications of the fit values. Then methods outlined below systematically adjusted patterns of missingness to mimic reduced and adapted subsets. Once the smaller NS item sets were delineated, several methods of adding predictive accuracy were tested and compared. In scoring respondents a traditional Item Response Theory (IRT) model as proposed by Rasch (1960) was first used to provide evidence for a uni-dimensional scale and obtain baseline statistics for item difficulty and person abilities. The next model was a Conditionally Independent Response Time (CIRT) model. The latter model includes a response model as well as a joint response time model for scoring. It was shown that with the full item set these two models provide identical ability estimates and item parameters. The response time model of the CIRT framework provides ability scores and speededness scores based on response time patterns. Next, focus was placed on effectively decreasing the number of items used in scoring each respondent. Methods included item reduction, test forms in which the same item sets were used to score each respondent, and adaptive tests, where each respondent could receive a different item set. Reduced item sets fared better when item difficulties more closely matched sample ability levels (r=0.72-0.90). Adaptive item sets were more consistent in measuring ability (i.e. half-adaptive, block adaptive, fully adaptive), but accuracy was best for the fully adaptive method used (r=0.79-0.91). The last steps of analysis involved introducing response time and demographic variables as additional predictors of the 30 item scores. Item response, response times, and response/response time interactions provided small improvements in explained variance when used as predictors (1-8%). When CIRT ability and speededness scores were used as predictors, speededness provided limited improvements (<1%) to prediction. The addition of age, education, and gender to response models improved explained variance to a moderate degree (1-5%). In conclusion, we note that sample had a higher than average ability level for the NS task and this should color our findings for the methods outlined. The item sets that did not match respondent abilities as well were improved more so by response time and demographic data. If one can correctly identify the ability ranges of a sample before administration, then a more focused reduced item set would be advantageous. Adaptive item sets seem advantageous in a more general testing situation where ability levels are more variable. The advantage of using collateral information in predicting cognitive scores is the amount of time saved by omitting items, potentially lowering costs, and allowing researchers to move onto more tasks if desired. While the improvement due to response time in these methods was limited with NS, there is a good foundation for other cognitive tasks administered in computer assisted designs.
Keywords: Health Conditions and Status; Healthcare; Methodology; Other

Gender and racial disparities in cost-related medication nonadherence: The effect of Medicare Part D and factors impacting compliance among older women and Black Americans - Bakk, Louanne (Michigan State University, 2012)
The purpose of this dissertation is to better understand how cost-related medication nonadherence (CRN) has been impacted by the implementation of Medicare Part D. This dissertation is comprised of three discrete empirical manuscripts, with introductory and concluding essays. Cumulative advantage/disadvantage theory was used as a foundation for understanding the effectiveness of Medicare Part D. Longitudinal and cross-sectional analyses were conducted using data from the Health and Retirement Study (HRS) and the Prescription Drug Study (PDS), a subsample of the HRS, to examine racial and gender differences in CRN before and after the implementation of Medicare Part D and factors associated with the benefit that can potentially impact adherence. In particular, this study addressed the following questions: (1) To what extent do racial and gender disparities in CRN exist since the implementation of Medicare Part D? (2) Do the Medicare Part D Low-Income Subsidy (LIS), coverage gap, and restrictions directly and indirectly affect the relationship between race, gender, and CRN? and (3) How do factors associated with cumulative advantage/disadvantage theory, specifically socioeconomic and health status, directly and indirectly affect the relationship between race, gender, and CRN? The results suggest that older Black Americans and females are more likely to report CRN before and after Medicare Part D than older Whites and males. Applying for the LIS increases the risk of CRN and mediates gender differences. Racial disparities in CRN appear to be driven by having a Medicare Part D plan with a gap in coverage. Poorer health and lower annual income increases the likelihood of CRN, even after controlling for LIS status and Medicare Part D's cost containment provisions. Further, experiencing the coverage gap and restrictions have a direct effect on nonadherence due to cost. The findings provide important insights into Medicare Part D's effectiveness in eliminating racial and gender differentials in CRN. Implications for practice, policy, education, and future research are discussed.
Keywords: Demographics; Health Conditions and Status; Medicare/Medicaid/Health Insurance; Public Policy; Women and Minorities

The Great Recession, Older Workers with Disabilities, and Implications for Retirement Security - Onur Altindag; Lucie Schmidt; Purvi Sevak (MRDRC Working Paper, 2012)
Evidence suggests that older workers with disabilities have been hit particularly hard by the recent recession. The increased difficulty in finding a job faced by individuals with disabilities, combined with the longer spells of unemployment experienced by all workers in this recession, could mean that laid-off disabled workers in their pre-retirement years may never return to work. In this paper, we use data from the 2004-2010 waves of the Health and Retirement Study to examine how the great recession has affected workers with chronic health conditions that put them at greater risk of disability. Our results suggest that increases in job losses were 30 greater for those with greater underlying risk of disability than for the general HRS population, and decreases in consumption were 20 greater. These results have important implications for the well-being of disabled individuals nearing retirement.
Keywords: Disabilities; Employment and Labor Force; Health Conditions and Status; Public Policy; Retirement Planning and Satisfaction

Health Disparities among the U.S. Elderly - Heesoo Joo (State University of New York at Albany, 2012)
This dissertation examines health disparities related to race/ethnicity and socioeconomic status among the U.S. elderly taking into account empirical challenges including: (1) self-selection and unobserved factors; (2) subjective and objective measures of disease; and (3) attrition bias. Using the 2006 Health and Retirement Study, we find that current estimates of racial/ethnic disparities in awareness of chronic disease are sensitive to self-selection and unobserved factors. Contrary to prior studies reporting that African-Americans are more aware of having hypertension than non-Latino whites, we do not find this conclusion to be true after controlling for self-selection and disease severity. Likewise, prior studies show mixed evidence of racial/ethnic disparities in awareness of diabetes, but after accounting for selection, we find that African-Americans and Latinos are less aware of having diabetes compared to non-Latino whites. Using the National Health and Nutrition Examination Survey from 1999-2008, we find that education is not associated with self-reported measures of diabetes and hypertension, and it is positively associated with self-reported high cholesterol. However, there is a strong negative association between education and diabetes and hypertension when we use objective measures. There is no association between education and objective measures of high cholesterol. When we account for the possibility of shared, unmeasured determinants of disease prevalence and diagnosis that are correlated with education, we find that education is negatively associated with having undiagnosed hypertension and diabetes. In addition, we find that trends in cardiovascular disease (CVD) risk factors, including (1) high blood glucose, (2) high blood pressure, (3) high cholesterol, and (4) smoking, improved over the past two decades among individuals with diabetes, but racial/ethnic and education-related disparities have emerged in some areas. Finally, we estimate income-related health inequality, measured by the concentration index with an unbalanced panel dataset, explicitly accounting for attrition due to mortality, using the RAND version of HRS. We find that income-related health inequality improves as people age, but this improvement primarily comes from the high mortality rate among poorer individuals. A balanced panel dataset analysis generates misleading results of progressive health deterioration, while an unbalanced panel dataset analysis brings out this regressive deterioration.
Keywords: Demographics; Health Conditions and Status; Healthcare; Women and Minorities

Health Insurance Decision Making in an Aging Population: A Medicare Part D Study - Lin, Iris L. (New York University, 2012)
A consumer-driven health care system with greater competition and choice has been welcomed as a policy solution, both to control costs and improve quality. In this more consumer-centric environment, the individual bears greater responsibility to obtain, understand, and act upon health information. However, researchers have observed a range of scenarios under which individuals struggle with understanding health information and do not make what are generally considered optimal decisions. This is particularly a concern for older adults who have a higher volume of medical needs and who may experience declining cognition. There is limited understanding about how the elderly make health-related decisions and what methods are most effective in providing support. This dissertation aims to investigate health related decision making in an aging population, specifically, how adults 65 years or older select their Medicare Prescription Drug Coverage (Part D). The study uses plan-level data from the Centers for Medicare and Medicaid Services and individual-level longitudinal survey data from the Health and Retirement Study. The first chapter of this dissertation examines the role of individual preferences and non-cost related plan attributes in Part D plan selection. The second chapter provides evidence of how aspects of an individual's social environment and use of information resources factor into selecting a plan. The final chapter analyzes potential motivators for individuals to switch plans.
Keywords: Demographics; Health Conditions and Status; Medicare/Medicaid/Health Insurance; Public Policy

Health services use and health status among people with diabetes mellitus and cardiovascular diseases - Li, Chien-Ching (Public Health Studies, 2012)
In the United States, Diabetes Mellitus (DM) becomes an important public health issue and has a great impact on health care costs. Diabetic patients are at a higher risk of developing cardiovascular diseases (CVD) compared to people without DM. This study adopted the Andersen's Behavioral Model of Health Services Utilization as a framework to examine health services uses and to further identify the association of health services uses and subsequent health outcomes within a representative sample of community-dwelling adults aged 51 years and older through a longitudinal analysis of the Health and Retirement Study data from 1998 through 2008. Results showed that less discretionary health services use (hospitalization and home health care) was more likely to be influenced by need factors. More discretionary health services use (doctor visits) was more likely to be influenced by predisposing factors. Although most health services uses were associated with worse or declined status in activities of daily living (ADL), instrumental activities of daily living (IADL), or self-rated health, certain health services use were found to be associated with less worse or not declined health status. The use of outpatient surgery among people with CVD only and the use of home health care among people with DM and CVD were associated with not declined IADL and self-rated health, respectively. In addition, the association between nursing home care and ADL, prescription drug use and IADL, and home health care and self-rated health was found to be different by health groups. Most health services uses were associated with higher risk of 10-year mortality. People with DM and CVD had the greater hazard to death compared with people with DM only. The association between mortality and doctor visits after baseline, and hospitalizations after baseline was different by health groups. Our study findings can provide health care professionals and health care administrators the insight required for improving the health care practice and the quality of health care in the U.S.
Keywords: Health Conditions and Status; Healthcare; Public Policy

How do the risks of living long and facing high medical expenses affect the elderly's saving behavior? - Mariacristina De Nardi; Eric French; John Bailey Jones (Chicago Fed Letter, 2012)
Although the elderly have a lot of wealth, people still do not fully understand their patterns of saving behavior. Many elderly individuals keep large amounts of wealth even as they near the ends of their lives. Furthermore, as one study shows, income-rich households are especially frugal. Among the motivations for saving are the risks of living long and having high medical expenses in old age. In recent research, the authors quantify the importance of forces by estimating and simulating a rich model of saving behavior. Life spans vary greatly in both predictable and unpredictable ways. Using mortality rates estimated from the AHEAD, they find that rich people, women, and healthy people live much longer than their poor, male, and sick counterparts. The risk of living far past one's expected life span is large and, under incomplete annuitization, a potentially important reason why so many elderly people run down their assets so slowly.
Keywords: Adult children; Consumption and Savings; Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction

The Importance of Anti-Discrimination and Workers' Compensation Laws on the Provision of Workplace Accommodations Following the Onset of a Disability - R.V. Burkhauser; Maximilian D. Schmeiser; Robert R. Weathers II (Industrial and Labor Relations Review, 2012)
The Americans with Disabilities Act of 1990 (ADA) was the first federal disability-based anti-discrimination law that applied to a broad range of workers. Whereas some studies have focused on its impact on workplace accommodation, this is the first to do so while accounting for previous state anti-discrimination and Workers' Compensation laws. Using data from the Health and Retirement Study, the authors find that prior to the implementation of the ADA, employers were more likely to accommodate workers if their disability onset was work-related and hence likely to be covered by Workers' Compensation laws. State anti-discrimination laws significantly increased accommodations to workers whose disabilities were not work-related, effectively bringing their accommodation rates in line with workers whose disabilities were. Though implementation of the ADA increased accommodation for all workers, the authors point out that failure to account for pre-existing state anti-discrimination and Workers' Compensation laws will underestimate its effect. PUBLICATION ABSTRACT
Keywords: Employment and Labor Force; Health Conditions and Status; Other

The Interplay of Wealth, Retirement Decisions, Policy and Economic Shocks - John Karl Scholz; Ananth Seshadri (Ann Arbor, The University of Michigan, 2012)
We develop a model of health investments and consumption over the life cycle where health affects longevity, provides flow utility, and retirement is endogenous. We develop a rich, numerical life-cycle model to study the complex interrelationship between health and wealth and the age of retirement. The decision to retire depends on a number of factors including earnings and health shocks, demographic characteristics, preferences, pensions, and social security. We incorporate these features in a computational model of optimal wealth and retirement decisions, solving the model household-by-household using data from the HRS. We use the model to study how workers would respond to an increase in the early eligibility age of retirement (EEA), and to what extent will the bad economy alter retirement plans. We find that increasing the EEA results in sizeable responses to the age of retirement but does not affect health outcomes very much. A 20 percent reduction in wealth induces households to delay retirement by one year, on average, with poor households being relatively unaffected.
Keywords: Consumption and Savings; Demographics; Event History/Life Cycle; Health Conditions and Status; Healthcare; Net Worth and Assets; Retirement Planning and Satisfaction; Social Security

Living Well: Empirical Evaluations of Economic Welfare and Subjective Well-Being - Horner, Elizabeth Mokyr (University of California, Berkeley, 2012)
This thesis presents findings from three related but independent research projects on how policies and programs affect subjective well-being and psychological health, both generally and along specific domains. As I discuss in the Introduction (Chapter 1), the subjective experience is an important component of overall welfare, and tools for measuring Subjective Well-Being (SWB) are well validated. These measures are particularly useful when measuring the impact of policies, programs, and decisions for which income is a poor indicator of well-being. The first project, "Subjective Well-Being and Retirement: Analysis and Policy Recommendations" (Chapter 2) examines how individual-level happiness is on average influenced by the transition into retirement. By exploiting discontinuities in retirement incentives in 16 countries, an instrumental variables approach is utilized to estimate retirement so that it is exogenous to individual-level characteristics. Removing selection bias reveals a large, short-term positive effect followed by a steep decline. This supports theories of a multi-stage adjustment to retirement. Further, individuals facing later formal retirement experience a boost in SWB that is roughly equivalent in total value to those individual facing earlier retirement, suggesting that raising the formal retirement age is relatively neutral with regard to SWB in the long-term. The second project, "Whose Fault Is It?: No Fault Divorce and the Decline in Women's Happiness" (Chapter 3) explores the impact of the no-fault revolution, wherein the legal and economic barriers to divorce were drastically reduced in many states throughout the 70s and 80s. I expand upon previous research by including SWB as an important outcome, including overall SWB as well as marital-happiness, a domain-specific SWB measure. I find that women under low-barriers to divorce regimes are significantly less happy than other women, while men are significantly happier. The final project, "Paradox Lost?: Job Satisfaction, Gender Segregation, and the Paradox of the Contented Female Worker" investigates whether gender segregation has played a role in the well-documented "paradox of the contented female worker" (Crosby, 1982), wherein women report higher job satisfaction despite worse work conditions. Job satisfaction is a domain-specific form of SWB which is particularly important from an economic perspective, as high SWB at work is related to better productivity and lower turnover. I find that both men and women are happier in jobs that are dominated by women, suggesting that men and women may on average be making different decisions with regard to satisfaction / income tradeoffs. Although the chapters are meant to be stand-alone essays, in concert these papers argue that: 1) SWB is an important outcome variable and high levels of SWB is an important social goal; and 2) policies affect SWB and therefore SWB must be considered in cost-benefit analyses of policy impacts.
Keywords: Adult children; Employment and Labor Force; Expectations; Health Conditions and Status; Methodology; Public Policy; Women and Minorities

Longitudinal Data Analysis: a Practical Guide for Researchers In Aging, Health, And Social Sciences - Jason T Newsom; Richard N Jones; Scott M Hofer (Routledge, 2012)
This book provides accessible treatment to state-of-the-art approaches to analyzing longitudinal studies. Comprehensive coverage of the most popular analysis tools allows readers to pick and choose the techniques that best fit their research. The analyses are illustrated with examples from 12 major longitudinal data sets including practical information about their content and design. Illustrations from popular software packages offer tips on how to interpret the results. Each chapter features suggested readings fur further study and a list of articles that further illustrate how to implement the analysis and report the results. An accompanying website provides syntax examples for several software packages for each of the chapter examples. Although many of the examples address health or social science questions related to aging, readers from other disciplines will find the analyses relevant to their work. In addition to demonstrating statistical analysis of longitudinal data, the book shows how to interpret and analyze the results within the context of the research design. Although most chapters emphasize the use of large studies collected over long term periods, much of the book is also relevant to researchers who analyze data collected in shorter time periods. The book opens with issues related to using publicly available data sets including a description of the goals, designs, and measures of the data. The next 10 chapters provide non-technical, practical introductions to the concepts and issues relevant to longitudinal analysis, including: weighting samples and adjusting designs for longitudinal studies; missing data and attrition; measurement issues related to longitudinal research; the use of ANOVA and regression for averaging change over time; mediation analysis for analyzing causal processes; growth curve models using multilevel regression; longitudinal hypotheses using structural equation modeling (SEM); latent growth curve models for evaluating individual trajectories of change; dynamic SEM models of change; and survival (event) analysis. Examples from longitudinal data sets such as the Health and Retirement Study, the Longitudinal Study of Aging, and Established Populations for Epidemiologic Studies of the Elderly as well as international data sets such as the Canadian National Population Health Survey and the English Longitudinal Study of Aging, illustrate key concepts. An ideal supplement for graduate level courses on data analysis and/or longitudinal modeling taught in psychology, gerontology, human development, family studies, medicine, sociology, social work, and other behavioral, social, and health sciences, this multidisciplinary book will also appeal to researchers in these fields.
Keywords: Cross-National; Health Conditions and Status; Methodology

A Longitudinal Study of Social Status, Perceived Discrimination, and Physical and Emotional Health Among Older Adults - Ye Luo; Jun Xu; Granberg, E.; Wentworth, W. (Research on Aging, 2012)
This study examines the relationships between social status, perceived discrimination, and physical and emotional health using a nationally representative sample of 6,377 older adults from the 2006 and 2008 waves of the Health and Retirement Study. About 63 of older adults reported at least one type of everyday discrimination and 31 reported at least one major discriminatory event during lifetime. Blacks, those separated, divorced, or widowed, and those with lower household assets have higher levels of perceived discrimination than Whites, the married or partnered, and those with more assets. Perceived discrimination is negatively associated with changes in health over 2 years, and everyday discrimination has stronger effects than major discriminatory events, especially on emotional health. The effects of perceived everyday discrimination on changes in depressive symptoms and self-rated health are independent of general stress. Efforts to reduce discrimination, including perceptions of discrimination, can be beneficial for health in old age. PUBLICATION ABSTRACT
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Women and Minorities

Medicare expenditure growth and its health returns across cohorts - Yi-Sheng Chao (Rutgers, The State University of New Jersey, 2012)
There are several key findings in the following chapters. In Chapter 2, the individual characteristics associated with higher spending growth over the period 1996 to 2008 were identified based on analyses with pooled cross-sectional data from the Medical Expenditure Panel Survey. The key factors that were associated with the adjusted growth rates higher than the actual Medicare spending growth rate (5.8% annually) from 1996 to 2008 include races other than the whites and blacks, Hispanic origin, high income, residence in the West, and very good health status. Findings from Chapter 3 reveal that enrollment in HMOs under Medicare is not random, but is systematically related to characteristics of Medicare enrollees. Using the longitudinal Health and Retirement Study, there were factors associated with a higher likelihood of becoming enrolled in Medicare Advantage/Part C. Chapter 4 examines the relationship between health care spending and returns to health with regard to five dimensions of health: mortality, hypertension, arthritis, self-assessed health status and mental health status (Center for Epidemiologic Studies Depression scale, CESD scale). The pre-Medicare characteristics were used to predict the change in these five dimensions of health after four years of Medicare coverage. The results reveal that increases in Medicare total and out-of-pocket spending were associated with poor health outcomes. Total spending was associated with a higher likelihood of death, worse self-rated health status (five categories) and mental health status. The increase in out-of-pocket health expenditure was associated with a higher chance of getting a worse category in self-rated health status after controlling for health status and other characteristics before being enrolled in Medicare. The findings of these studies suggest that policies to constrain Medicare spending should recognize and target the multiple factors contributing to Medicare expenditure growth and the dubious returns to health, as well as target integrated care for Medicare enrollees and incentives for individuals to prevent the onset of chronic health conditions.
Keywords: Consumption and Savings; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Public Policy

The Motivation for Intergenerational Time and Financial Transfers - Saeeun Choi; Chatterjee, Swarn; Kim, Haejeong (Family and Consumer Sciences Research Journal, 2012)
This study investigated the motivation for intergenerational financial and time transfers between parents and adult children using data from the Health and Retirement Study. The results showed that emotional closeness between parents and adult children was significantly associated with both adult children to parent and parent to adult children transfers. In addition, parents and adult children who met frequently were more likely to help each other by making financial or time transfers. Also, financial transfers between parents and adult children were motivated by the donor's altruism to the disadvantaged adult children or parents. However, wealthier parents and adult children with full-time jobs were less likely to make time transfers. The results of this study help in understanding the motivation for various types of intergenerational transfers in an aging society. PUBLICATION ABSTRACT
Keywords: Adult children; Health Conditions and Status

Neighborhood Conditions and Gender Differences in Depressive Symptoms - Clinton, Eliva Atieno (University of California, Los Angeles, 2012)
Depression is a major public health challenge affecting millions of people worldwide, particularly women. Intra-individual explanations of gender differences in depression include biology (e.g., neurotransmitters, genes, hormones) and psychological factors (e.g., self-concept and esteem, mastery). Social explanations focusing on exposure to stressors (e.g., low socioeconomic status) and social role occupancy (e.g., marital and employment status) also have been considered. The recognition that environmental factors may influence mental health has given rise to studies examining the relationship between neighborhood conditions and risk for depression and psychological distress, but gender differences in neighborhood effects have yet to receive the needed research attention. This dissertation sought an understanding of: (a) gender differences in neighborhood effects on depressive symptoms, and (b) neighborhood influences on variation in depressive symptoms among women. The research is guided by the neighborhood stress process framework focusing on stressors and psychosocial resources as mediators and moderators of the relationships among neighborhood conditions and depressive symptoms. Individual-level cross-sectional data come from the Health and Retirement Survey (HRS: baseline, 2006/2008 interviews and psychosocial questionnaire supplement). The HRS is a U.S. national probability sample of adults over the age of 50. Analyses are performed within a multilevel framework and urban neighborhood data come from the 2000 U.S. Census. Among eight indicators of neighborhood disadvantage, including neighborhood socioeconomic disadvantage (NSD), and five measures of neighborhood advantage examined for gender differences in their effects on depressive symptoms, two were statistically significant but not in the expected direction. Neighborhood proportion non-family households was associated with fewer depressive symptoms among women and it had no effect among men. Neighborhood proportion married-couple households was not significantly related to depressive symptoms among women, but among men, living in a neighborhood with more married-couple households with children was associated with fewer symptoms. Overall, the impact on depressive symptoms of neighborhood characteristics do not differ for men and women. Gender differences in neighborhood effects on three individual-level stressors and three individual-level psychosocial resources also were examined. Nine interactions were statistically significant. Consistent with expectations, people who reside in neighborhoods with more vacant housing units perceived more disorder and less social cohesion in their neighborhoods, and the effects were larger for women than men. Relative to men, women's perceptions of neighborhood social cohesion and social support are more sensitive to neighborhood economic conditions. In general, with a few notable exceptions, neighborhood effects on stressors and psychosocial resources do not vary by gender. In analyses that only included women, NSD was positive and significantly associated with depressive symptoms and neighborhood proportion adults aged 65 and older was negative and significantly associated with symptoms. Perceived neighborhood social cohesion fully mediated the effect of NSD--and partially mediated the effect of neighborhood proportion older adults--on depressive symptoms. The effect on depressive symptoms of neighborhood disadvantage did not vary significantly by levels of stressors and psychosocial resources except for three significant cross-level interactions. Living in a neighborhood with more vacant housing units was associated with more depressive symptoms, and the effect was greater among women who perceived high levels of disorder in the neighborhood than those who perceived less disorder. Also as hypothesized, NSD had the largest positive effect on depressive symptoms among women with less social support than women with more support. However, mastery did not funct on as a stress-buffer. The effect on depressive symptoms of neighb rhood advantage varied significantly by psychosocial factors. Living in a neighborhood with higher proportions of older adults was associated with fewer depressive symptoms more so for women who report low levels of perceived neighborhood physical disorder than women who report average levels of disorder. Also consistent with expectations, higher neighborhood proportion of affluent households and owner-occupied housing units were associated with fewer depressive symptoms, and the effects were larger for women with high levels of mastery than women with low mastery. However, these neighborhood characteristics were less beneficial to the mental health of women with high than low levels of social support. The findings from this dissertation largely indicate that relationships among components of the neighborhood stress process model do not differ by gender or by levels of stressors and psychosocial resources. However, the significant results that emerged make a valuable contribution to the research literature by identifying urban neighborhood conditions that are consequential to the mental health of middle-aged and older adults and that should be the target of interventions.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology; Public Policy; Women and Minorities

Non-Invasive Sensor Solutions for Activity Recognition in Smart Homes - Srinivasan, Vijay (University of Virginia, 2012)
Smart home sensor systems that infer residents' activities enable a number of exciting medical monitoring and energy conservation applications. Existing home activity recognition systems are invasive , since they require significant manual effort from the end user in installing or training the system, inconvenience the resident by requiring them to constantly wear tags, or require invasive cameras or expensive sensors. Our main hypothesis is that by effectively using data fusion techniques, leveraging the existing smart meter infrastructure in homes, and using only weak biometric sensing, we can build convenient, accurate home activity recognition solutions for the end user. The key challenges for home activity recognition systems addressed in this dissertation include reducing configuration effort from the end user, reducing sensor installation effort, and identifying residents in multi-person homes without using invasive sensors. To reduce user configuration effort, we develop an unsupervised activity recognition algorithm called AUTOLABEL that leverages data fusion and cross-home activity models to accurately recognize resident activities without user training. To eliminate many direct sensors in the home for activity recognition, we develop effective Bayesian data fusion techniques, which combine the existing smart meter infrastructure in homes, with one low cost, non-invasive sensor per room. In our WaterSense approach, we combine a single smart water meter per home, with an occupancy sensor per room to eliminate direct sensors on individual water fixtures. In our LightSense approach, we combine a single smart energy meter per home with a light sensor per room, to eliminate direct sensors on individual light fixtures. Finally, we propose the use of resident height, which is a weak biometric, in an effective data fusion approach, to identify residents for activity recognition in multi-person homes. We evaluate our proposed activity recognition solutions through short term prototype sensor deployments in home environments lasting from 7 to 10 days each. We show that our low cost, convenient solutions satisfy the activity recognition needs of numerous smart home applications, such as remote medical monitoring for elderly residents, and fine-grained resource consumption monitoring of light and water fixtures in the home. Finally, we observe that our unsupervised activity recognition algorithm can be used in a wireless snoop attack on smart homes, to infer the residents' daily activities with high accuracy in spite of encrypted wireless transmissions. We propose and evaluate a suite of privacy solutions to mitigate the inference accuracy of such an attack without affecting the performance or functionality of the home activity recognition system.
Keywords: Health Conditions and Status; Methodology; Other

Obesity, Depression, and Employment Related Outcomes Among Workers Near Retirement - Mustafa C. Karakus; Okunade, A. (Ageing International, 2012)
Obese individuals with comorbid depression face greater risks of atrophied health status alongside the associated adverse consequences, such as limitations of daily living and/or work related activities. This study uses the U.S. Health and Retirement Study database to investigate the likelihood of early retirement decisions (before age 62) of older working-age adults (ages 50 to 62). We find that obese subjects with comorbid depression are significantly more likely to reduce work-hours and seek early retirement. Survival models confirm the negative association between obesity with comorbid depression and the duration to early retirement. The bidirectional association between obesity and depression suggest that more carefully designed public policy interventions are necessary for improving the labor market attachments of the older working-age adults that are obese and clinically depressed. PUBLICATION ABSTRACT
Keywords: Health Conditions and Status; Methodology; Public Policy; Retirement Planning and Satisfaction

Pensions and Household Saving in The United States - Chang, Fei-Chien (University of Washington, 2012)
The goal of this research is to examine the effects of employer-provided pensions and Social Security on household saving in the United States. Current interest has intensified because of increasing concerns about insufficient saving for retirement, a trend in pensions from defined benefit to defined contribution plans, and a projected financial shortfall in Social Security. Specifically, the debate about whether higher pension benefits "crowd out" private saving has come under sharper focus among researchers and policymakers. If there is a full offset effect of pensions on private saving, then policies targeted to raise pension wealth may not necessarily increase overall retirement saving because households will decrease their private wealth accumulation instead. Three methodologies were employed in Chapters 2 through 4 to empirically identify the offset effects using improved data in the Health and Retirement Study (HRS). Chapter 2 presents a cross-sectional analysis in 1992. The findings show a significant but not dollar-for-dollar crowding-out effect for employer-provided defined benefit pensions and little to no offset effect for defined contribution pension and Social Security. To overcome the estimation problems such as unobserved omitted variables and insufficient variation in Social Security wealth when conducting a cross-sectional analysis, I utilize the panel structure of HRS and the recent Social Security reforms to introduce independent variation in pension wealth over time. A panel analysis using HRS data from year 1992, 1998, and 2004 is presented in Chapter 3. The panel analysis shows a statistically significant full offset effect between pensions and private saving in some specifications. Chapter 4 presents the effects of Social Security benefits withheld under the earnings test on household saving. I find evidence for a full offset effect between household saving and benefit withholding under the earnings test for those aged between 62 and normal retirement age and those with higher educational attainment. In summary, this research supports the theory that pensions crowd out private wealth accumulation.
Keywords: Consumption and Savings; Health Conditions and Status; Net Worth and Assets; Pensions; Public Policy; Social Security

Personality Traits and Economic Preparation for Retirement - Michael D Hurd; Angela Lee Duckworth; Susann Rohwedder; David R Weir (MRDRC Working Paper, 2012)
This paper assesses the effects of personality traits on economic preparation for retirement, wealth accumulation, and consumption, among persons 66 to 69 years of age. Among the five chief personality traits of neuroticism, extroversion, agreeableness, conscientiousness, and openness, we focus most on conscientiousness. We find levels of adequate economic preparation for retirement ranging from 29 percent to 90 percent and that conscientiousness positively affects the proportion of persons adequately prepared for retirement, while neuroticism negatively affects it. Both consumption and wealth increase with conscientiousness but wealth increases faster, indicating that more conscientious persons save more out of retirement resources.
Keywords: Consumption and Savings; Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction

Prevalence of Health Conditions and Predictors of Mortality in Oldest Old Mexican Americans and Non-Hispanic Whites - Samper-Ternent, Rafael; Kuo, Yong Fang; Ray, Laura A.; Ottenbacher, Kenneth J.; Kyriakos S Markides; Soham Al Snih (Journal of the American Medical Directors Association, 2012)
Background The oldest old represent a unique group of older adults. This group is rapidly growing worldwide and yet there are gaps in the knowledge related to their health condition. Ethnic differences in disease prevalence and mortality must be understood to better care for the oldest old. Objective To compare prevalence of common health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic Whites. Methods This study included 568 community dwelling Mexican Americans (MA) aged 85 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) 2004-2005 and 933 non-Hispanic Whites (NHW) of the same age from the Health and Retirement Study (HRS) 2004. Measures included socio-demographic variables, self-reported medical conditions, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression analysis was used to examine two-year mortality in both populations. Results Heart attack was significantly more prevalent in oldest old NHW compared to MA, regardless of gender. Conversely, diabetes was significantly more prevalent among MA men and women compared to their NHW counterparts. Compared to NHW men MA men had significantly higher prevalence of cognitive impairment and hypertension. Additionally, prevalence of hip fracture was significantly higher for MA women compared to NHW women. Significant differences in ADL disability were observed only between both groups of women while significant differences in IADL disability were only observed between men. MA men and women had higher prevalence of obesity compared to NHW. Predictors of two-year mortality for both ethnic groups included older age, male gender, and ADL disability. Cognitive impairment was only a mortality predictor for NHW. Similarly, lung disease was only a predictor for MA. Conclusion Health related conditions that affect the oldest old vary by gender and ethnicity and entail careful evaluation and monitoring in the clinical setting. Better care requires inclusion of such differences as part of the comprehensive evaluation of oldest old adults.
Keywords: Cross-National; Health Conditions and Status; Immigrants; Mortality; Racial/ethnic differences; Women and Minorities

Religion, spirituality and aging: A longitudinal study of mental and physical coping - Nathenson, Sophia Lyn (The University of Utah, 2012)
A connection to the divine, God, or nature can be a source of comfort, guidance and insight, particularly during times of hardship or illness. This study draws together sociological theories on religion, aging and health to explore the ways in which religious and spiritual practices may impact the mental and physical aspects of old age. Analyzing data from the Health and Retirement Study (HRS) from 2000 to 2010, the effects of religious salience, prayer and meditation are investigated in terms of their impact on mental health and physical functioning. Additionally the study examines a sample of cancer survivors to determine if the effects of religion differ for this unique population. Results demonstrated a salutary effect of religious salience on mental health and coping with cancer, but a negative association with disability. Similarly, moderate prayer improved outcomes of depression and disability while daily prayer and meditation was associated with poorer outcomes. Theoretical explanations for these results are discussed with respect to policy implications and future research directions.
Keywords: Adult children; Demographics; Health Conditions and Status

Retirement Security: Older Women Remain at Risk - Statement of Barbara D. Bovbjerg - United States Governmental Office (Washington, DC, 2012)
This testimony examines women s retirement income security based on a GAO report that examined (1) how women s access to and participation in employer-sponsored retirement plans compare to men s and how they have changed over time; (2) how women s retirement income compares to men s and how the composition of their income the proportion of income coming from different sources changed with economic conditions and trends in pension design; (3) how later-in-life events affect women s retirement income security; and (4) what policy options are available to help increase women s retirement income security.
Keywords: Consumption and Savings; Health Conditions and Status; Income; Public Policy; Retirement Planning and Satisfaction; Women and Minorities

Retirement Security: Women Still Face Challenges - United States Governmental Office (Washington, DC, U.S. Government Accountability Office, 2012)
This report examines (1) how women s access to and participation in employer-sponsored retirement plans compare to men s and how they have changed over time, (2) how women s retirement income compares to men s and how the composition of their income changed with economic conditions and trends in pension design, (3) how events occurring later in life affect women s retirement income security, and (4) what policy options are available to help increase women s retirement income security.
Keywords: Consumption and Savings; Health Conditions and Status; Income; Public Policy; Retirement Planning and Satisfaction; Women and Minorities

Sense of control and sociodemographic differences in self-reported health in older adults - Ward, Michael M. (Quality of Life Research, 2012)
Stronger sense of control has been associated with improved health outcomes. This study tested whether the association between sense of control and self-reported health varied among demographic groups and whether sense of control attenuated sociodemographic differences in self-reported health. Data from 6,815 participants in the Health and Retirement Study were used to examine moderation between demographic characteristics and sense of control (measured by the personal mastery and perceived constraints scales of the Midlife Developmental Inventory) in their associations with three self-reported health measures (global rating of fair/poor health, functional limitations, and number of comorbid conditions). Higher personal mastery and lower perceived constraints were associated with better self-reported health. There were no significant interactions between the sense of control measures and age, gender, education level, income, or marital status in their associations with either global self-rated health or functional limitations. Higher levels of mastery were associated with lower likelihood of functional limitations among blacks and whites, but not among those of other races. Perceived constraints were slightly more strongly associated with number of comorbid conditions among older than younger individuals. Sense of control measures were generally similarly associated with self-reported health across demographic groups and did not attenuate demographic differences in health. PUBLICATION ABSTRACT
Keywords: Demographics; Health Conditions and Status; Healthcare; Other

A simple measure with complex determinants: investigation of the correlates of self-rated health in older men and women from three continents - D. J. French; Chris Browning; Kendig, H.; Luszcz, M. A.; Saito, Yasuhiko; K. A. Sargent-Cox; Kaarin J. Anstey (Bmc Public Health, 2012)
Background: Self-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea. Methods: Cross-sectional data were drawn from large surveys of older respondents ( = 65 years) in Australia (n = 7,355), USA (n = 10,358), Japan (n = 3,541) and South Korea (n = 3,971), collected between 2000 and 2006. Harmonized variables were developed to represent socioeconomic, lifestyle and health indicators. We then assessed whether these variables, and their potentially different impact in different countries, could account for cross-national differences in levels of SRH. Results: SRH differed significantly between countries, with older Koreans reporting much poorer health than those in the other three nations. This was not the result of biases in response patterns (for example central versus extreme tendency). Health-related correlates of SRH were similar across countries; those with more medical conditions, functional limitations or poor mental health gave poorer ratings. After accounting for the differential impact of determinants in different national contexts, Australians reported better SRH than other nations. Conclusions: We conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country, and possibly cohort specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health.
Keywords: Cross-National; Health Conditions and Status; KLoSA; Methodology

Social Determinants and Depression in Later Life - Cross-Denny, Bronwyn (Fordham University, 2012)
The social determinants of health and mental health have come to the forefront as a global issue as a result of the World Health Organization's (WHO) initiative to close the health equity gap. The aim of this study is to examine social determinants and the impact on depression over the life span utilizing Cumulative Disadvantage Theory. A secondary data analysis was conducted on the 2010 wave of data from the Health and Retirement Study. A path analysis was used to determine predictors of depression in later life. Findings indicated that age and neighborhood cohesion were predictors of perceived discrimination. Although total causal effects were small for predictors of depression, results indicate a possible protective factor provided by neighborhood cohesion and social support. Implications for social work research and practice are discussed for addressing service needs of the growing older adult population.
Keywords: Adult children; Demographics; Health Conditions and Status; Methodology

Socioeconomic and Racial/Ethnic Disparities in Cognitive Trajectories among the Oldest Old: The Role of Vascular and Functional Health - Nicholas J Bishop (Arizona State University, 2012)
Identifying modifiable causes of chronic disease is essential to prepare for the needs of an aging population. Cognitive decline is a precursor to the development of Alzheimer's and other dementing diseases, representing some of the most prevalent and least understood sources of morbidity and mortality associated with aging. To contribute to the literature on cognitive aging, this work focuses on the role of vascular and physical health in the development of cognitive trajectories while accounting for the socioeconomic context where health disparities are developed. The Assets and Health Dynamics among the Oldest-Old study provided a nationally-representative sample of non-institutionalized adults age 65 and over in 1998, with biennial follow-up continuing until 2008. Latent growth models with adjustment for non-random missing data were used to assess vascular, physical, and social predictors of cognitive change. A core aim of this project was examining socioeconomic and racial/ethnic variation in vascular predictors of cognitive trajectories. Results indicated that diabetes and heart problems were directly related to an increased rate of memory decline in whites, where these risk factors were only associated with baseline word-recall for blacks when conditioned on gender and household assets. These results support the vascular hypotheses of cognitive aging and attest to the significance of socioeconomic and racial/ethnic variation in vascular influences on cognitive health. The second substantive portion of this dissertation used parallel process latent growth models to examine the co-development of cognitive and functional health. Initial word-recall scores were consistently associated with later functional limitations, but baseline functional limitations were not consistently associated with later word-recall scores. Gender and household income moderated this relationship, and indicators of lifecourse SES were better equipped to explain variation in initial cognitive and functional status than change in these measures over time. Overall, this work suggests that research examining associations between cognitive decline, chronic disease, and disability must account for the social context where individuals and their health develop. Also, these findings advocate that reducing socioeconomic and racial/ethnic disparities in cognitive health among the aging requires interventions early in the lifecourse, as disparities in cognitive trajectories were solidified prior to late old age.
Keywords: Demographics; Health Conditions and Status

Spousal support and diabetes management: The role of gender and religion - Estevez, Rosemary (University of North Texas, 2012)
One in four adults over the age of 60 suffers from diabetes. Around 85%-90% of individuals who have diabetes suffer from Type II diabetes. The prevalence of individuals with diabetes is expected to increase. This paper addresses the influence spousal support, friend support, and religion all have on diabetes mellitus. Gender difference in relation to spousal support benefits has also received limited attention. The limited amount of studies that have examined gender differences in relation to spousal support and diabetes management indicate that diabetic men benefit the most from spousal support due to their wives active involvement in meal preparation and grocery shopping. The results showed that neither spousal support nor religious salience was significantly related to diabetes management. There were observed gender differences in religious salience (males = 4.84, females = 5.36, p <.001) and positive spousal support (males = 3.19, females = 3.02, p <.001), but none of the major hypotheses were supported.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Public Policy

Is There a Hispanic Epidemiologic Paradox in Later Life? A Closer Look at Chronic Morbidity - Zhang, Zhenmei; Mark D Hayward; Lu, Chuntian (Research on Aging, 2012)
This study examined the morbidity patterns of foreign-born Hispanics, U.S.-born Hispanics, Blacks, and Whites aged 53 years and older using seven self-reported physician-diagnosed chronic diseases as well as six biomarkers. Drawing on the 2006 Health and Retirement Study and its biomarker data, the authors found that foreign-born Hispanics had comparable or lower rates of high blood pressure, heart disease, cancer, arthritis, chronic lung disease, and stroke, controlling for age and gender. The health advantages were robust when socioeconomic conditions and health behaviors were controlled. Foreign-born Hispanics were not significantly different from U.S.-born Hispanics except for a lower risk for arthritis. In terms of biomarkers, foreign-born Hispanics were not statistically different from Whites except for having higher risks of high systolic blood pressure and blood glucose. Future research should explore multiple factors contributing to the lower rates of major chronic diseases among older Hispanics who have faced social disadvantages over the life course. PUBLICATION ABSTRACT
Keywords: Demographics; Health Conditions and Status; Healthcare; Women and Minorities

Three essays in health economics - Wang, Xu (City University of New York, 2012)
This dissertation consists of three essays. In my first essay, I examine the relationship of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) to breastfeeding. Although WIC promotes breastfeeding among its participants through education, counseling, and the provision of enhanced food packages to breastfeeding women, the program has been criticized for discouraging breastfeeding by providing free infant formula. In order to estimate the extent to which participation in WIC discourages breastfeeding, I employ a methodology that disentangles selection bias associated with WIC participation from the incentives associated with the provision of free infant formula. Findings suggest that postpartum entrants are less likely to breastfed for at least 6 months and have shorter breastfeeding durations than non-participants, and the effects are significantly larger among twin mothers than among singleton mothers. In my second essay, I investigate the association between WIC participation and infant health. How effective WIC is at improving birth outcomes is under debate. Identifying treatment effect is challenged by selection bias and gestational age bias. We use twins to minimize selection bias associated with WIC participation because twin pregnancy increases the probability of adverse birth outcomes significantly but is unlikely related to other risky behaviors. Our focus is on measures of fetal growth as outcomes amenable to nutritional supplementation. Our findings from two national datasets, PNSS and ECLS-B, suggest that prenatal WIC participation has very limited effect on fetal growth. We do not find evidence of causal effect between WIC and better birth outcomes, especially among twin births. In my third essay, I turn my interest to a different research question, the association between retirement and alcohol consumption. Retirement is life transition whose significance may provoke lifestyle and health behavioral alterations such as alcohol consumption. We examine the effect of retirement on subsequent period alcohol consumption within a two period follow up. We use seven waves of the data from Health and Retirement Study (HRS) and found retirement lead to consume 1.3 more alcoholic drinks per day within men. No effect has been found within retired women.
Keywords: Event History/Life Cycle; Health Conditions and Status; Healthcare; Public Policy; Retirement Planning and Satisfaction

Three essays on health care spending - Yoo, Minkyoung (Rutgers The State University of New Jersey, 2012)
This dissertation is composed of three essays that consider the determinants and persistence of health care spending and how policies that control increasing health care costs affect the distribution of health care spending in the U.S. In the first essay, I study the association between education and health care spending for a set of health conditions amenable to self-management. Empirical findings from estimated health expenditure models reveal strong inverse relationships between education and health care spending among elderly adults with hypertension and/or asthma. Additionally, I find that greater educational attainment is associated with a reduced likelihood of being in the top 5% of health care spenders for elderly adults with hypertension and nonelderly adults with diabetes, and also with less severe conditions. The second essay assesses how the distribution of family out-of-pocket health care spending has been affected by changes in recent cost-sharing to understand the effectiveness of the risk protection function of private health insurance against high medical care expenses. The results suggest that families who rely more on health care because of one or more their member's existing health conditions are most affected by changes in cost sharing during the period 2001-2005 and the increased exposure to out-of-pocket spending occurrs primarily for families at higher percentiles of the out-of-pocket spending distribution, thus reducing the "return" to risk protection from holding private health insurance. The final essay examines the dynamics of out-of-pocket health care spending by looking at the persistence of such spending among Medicare beneficiaries. The findings suggest that having a certain chronic condition or a health shock clearly increases the probability of out-of-pocket health care spending persistence. Additionally, having an existing health insurance that supplements Medicare coverage or the acquisition of a new supplementary health insurance has a significant impact on the probability of persistence.
Keywords: Demographics; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Methodology; Other; Risk Taking

Three essays on the health and family behavior - Sikora, Joanna E. (Cornell University, 2012)
This dissertation is comprised of three papers on health and household behavior. Two of the papers focus on the influence of family on health outcomes. The third paper examines household member preferences and their association with outcomes for other individuals within the family unit. The first paper tests the relationship of adult-child and elderly-parent contact frequency on elderly cognitive functioning (dementia) using the Health and Retirement Study (HRS). The paper examines various mechanisms through which the intensity of contact with adult, nonresident children impacts elderly cognitive functioning. An instrumental variables model is used to account for the endogeneity in the level of parent-child contact. Results indicate a positive association between intensity of contact from nonresident adult children and mothers' cognitive functioning; however, no causal relationship is found suggesting that higher levels of contact are due to selection. The second paper examines the prediction of stated, altruistic, preferences on an individual's revealed preferences, observed intergenerational family transfers. Measures of altruism toward children and parents are constructed, using hypothetical questions in the 1996 wave of the HRS that assess individuals' willingness to transfer income to others, and evaluated for their additional explanatory power, within traditional models of intergenerational transfers, on observable transfer behavior. Results indicate that higher levels of altruistic preferences are associated with higher probabilities of transfers and larger transfer amounts from respondents to children; however, transfers to parents do not appear to be related to the altruism measure. The final paper investigates the link between relationship status and body mass index. There are four hypotheses (selection, protection, social obligation and marriage market) that might explain the relationship between marital status transitions and changes in Body Mass Index (BMI). Using the National Longitudinal Survey of Youth 1979, individual fixed effects models are estimated to examine associations between the change in log BMI, and the incidence of overweight and obesity, and changes in relationship status. There is no support for the marriage protection hypothesis. Rather evidence supports the social obligation and marriage market hypotheses--BMI increases for both men and women during marriage and in the course of a cohabiting relationship.
Keywords: Adult children; Demographics; Health Conditions and Status; Methodology; Public Policy

The Urban Neighborhood, Depressive Symptoms, and Age: Stress and Psychosocial Resources - Harig, Fredrick A. (University of California, Los Angeles, 2012)
Background . Existing research shows that residents exposed to neighborhood socioeconomic disadvantage (NSD) have a relatively high risk of some types of mental illness. This study investigated whether this pattern is present for depressive symptoms among persons in late middle age to extreme old age, and if so why. Investigated factors include: stressors (neighborhood physical disorder and financial strain) and psychosocial resources (mastery, social support, and religious service attendance). Age differences were examined. Methods . This was a secondary analysis of data from the 2006 and 2008 Health and Retirement Study Psychosocial Supplemental Assessment. The analytic sample included 8,623 adults aged 52 to 104, residing in 3216 urban neighborhoods (census tracts). NSD was operationalized with a principal component of Census tract indicators (education, poverty, public assistance, and unemployment). Depressive symptoms were measured by an 8-item version of the Center for Epidemiologic Studies Depression Scale. Hierarchical linear regression estimated multilevel models. Results . NSD was positively associated with depressive symptoms, net of individual-level demographic characteristics used to control for selection. Exposure to stressors partially explained the association; while psychosocial resources suppressed it. A significant, curvilinear cross-level interaction with age was found: NSD is positively associated with symptoms among those under 64, but has little effect among persons 65 to 74 year, and is negative at older ages. Conclusion . The mental health disparity for depressive symptoms in NSD is partially due to greater exposure to stressors and fewer resources to counteract this exposure. The counter-intuitive inverse association among the oldest adults warrants further investigation.
Keywords: Demographics; Health Conditions and Status; Healthcare; Public Policy; Risk Taking

Use of Direct Versus Indirect Approaches to Measure Loneliness in Later Life - Sharon Shiovitz-Ezra; Liat Ayalon (Research on Aging, 2012)
The aim of the current investigation was to compare a direct versus an indirect approach for measuring loneliness by comparing the one-item Center for Epidemiologic Studies Depression Scale, representing the direct approach, with the shortened version of the Revised UCLA Loneliness Scale, representing the indirect approach, using approximately 2,000 observations from the 2002 Health and Retirement Study. The authors artificially identified a cut point of 6 on the three-item Revised UCLA Loneliness Scale to potentially yield the most similar results to the single-item scale and demonstrate the best sensitivity and specificity. Nonetheless, a high rate of respondents (57 ) who reported being lonely on the direct item were classified as not lonely on the indirect scale. Inconsistency between the two approaches was also evident with regard to the associations between loneliness and age, as well as with education. These findings indicate that the different measures of loneliness provide a somewhat different picture of both the prevalence of loneliness and the characteristic of the people who suffer from it. PUBLICATION ABSTRACT
Keywords: Health Conditions and Status; Healthcare

Using factor mixture analysis to model heterogeneity, cognitive structure, and determinants of dementia: an application to the Aging, Demographics, and Memory Study - Cinzia Viroli (Statistics in Medicine, 2012)
The Aging, Demographics, and Memory Study is the first extensive study of cognitive impairment and dementia of population in the USA. A large sample of participants with ages 71?years or older has answered an in-depth questionnaire which included an extensive cognitive assessment. One of the principal aims of the study was to assign a diagnosis of dementia, cognitive impairment but not demented, or normal to the respondents. Because of this heterogeneity, we apply factor mixture model to the set of neuropsychological measures of the study in order to perform clustering of subjects and dimension reduction simultaneously. Moreover, we consider an extended variant of the model by incorporating a set of demographics and clinical covariates which directly affect the latent variables of the factor mixture model. The interest of the analysis is to investigate whether respondents exhibit the same association of overall cognitive functioning with the covariates or whether groups of respondents exist that exhibit different association with the covariates, indicating different determinants of overall cognitive functioning. Copyright (C) 2012 John Wiley and Sons, Ltd.
Keywords: Health Conditions and Status

Utility of the Abbreviated Fuld Object Memory Evaluation and MMSE for Detection of Dementia and Cognitive Impairment not Dementia in Diverse Ethnic Groups - Rideaux, T.; Sherry A. Beaudreau; Fernandez, S.; Ruth O'Hara (Journal of Alzheimers Disease, 2012)
To address the growing need for ethnically unbiased cognitive screening, we examined whether the Mini Mental State Exam (MMSE), the abbreviated Fuld Object Memory Evaluation (FOME), or a combination of the two provided optimal detection of dementia in an ethnically diverse group of older adults with no cognitive impairment (normal); cognitive impairment not dementia (CIND); and dementia. Participants included 509 Caucasians, 124 African Americans, and 68 Latinos ( 70 years old) from the Aging, Demographics, and Memory Study who completed the MMSE and FOME. Empirically derived decision trees were computed using signal detection software for receiver operator characteristics (ROC). Among the three ethnic groups, ROC analyses revealed that lower cut-scores on both the MMSE and FOME provided better detection of CIND or dementia. Sensitivity and specificity of the MMSE was augmented by the addition of the FOME among Caucasian and African American older adults. The MMSE alone was the best screen in Latino older adults to distinguish any cognitive impairment from normal. When comparing CIND versus dementia, however, the FOME alone was best for detecting dementia among Latinos. The abbreviated FOME is recommended to increase clinical validity and thus minimize ethnic biases when administering the MMSE to Caucasian and African American older adults. The MMSE alone is preferred for older Latinos unless comparing CIND and dementia, in which case the FOME alone would then be recommended. Findings suggest that ethnicity is important in the selection of an appropriate cognitive screen and cut-score to use with older adults.
Keywords: Health Conditions and Status; Methodology

Who Among the Elderly Owns Stocks? The Role of Cognitive Ability and Bequest Motive - Eun Jin Kim; Sherman D. Hanna; Chatterjee, Swarn; Lindamood, Suzanne (Journal of Family and Economic Issues, 2012)
Conventional advice is to reduce risky investments as one ages. Such a generalized focus on risk avoidance may be inappropriate for elderly with longer life spans and those with financial goals that extend beyond their lifetime. To better understand risky asset holdings among the elderly, we investigated the effect of cognitive ability and bequest motive on stock ownership and stock purchase. Using the 2004 wave of the Health and Retirement Study, we found that one-third of elderly households held stocks and 36 of those elderly stockowners had recently acquired stocks. The respondent's cognitive ability and bequest motive were strongly related to stock ownership. Among those who owned stock, a bequest motive was positively related to a recent purchase of stocks. PUBLICATION ABSTRACT
Keywords: Health Conditions and Status; Healthcare; Net Worth and Assets; Retirement Planning and Satisfaction

Why Do Life Insurance Policyholders Lapse? The Roles of Income, Health and Bequest Motive Shocks - Fang, Hanming; Kung, Edward (National Bureau of Economic Research, Inc, NBER Working Papers: 17899, 2012)
Previous research has shown that the reasons for lapsation have important implications regarding the effects of the emerging life settlement market on consumer welfare. We present and empirically implement a dynamic discrete choice model of life insurance decisions to assess the importance of various factors in explaining life insurance lapsations. In order to explain some key features in the data, our model incorporates serially correlated unobservable state variables which we deal with using posterior distributions of the unobservables simulated from Sequential Monte Carlo (SMC) method. We estimate the model using the life insurance holding information from the Health and Retirement Study (HRS) data. Counterfactual simulations using the estimates of our model suggest that a large fraction of life insurance lapsations are driven by i.i.d choice specific shocks, particularly when policyholders are relatively young. But as the remaining policyholders get older, the role of such i.i.d. shocks gets smaller, and more of their lapsations are driven either by income, health or bequest motive shocks. Income and health shocks are relatively more important than bequest motive shocks in explaining lapsations when policyholders are young, but as they age, the bequest motive shocks play a more important role. We also suggest the implications of these findings regarding the effects of the emerging life settlement market on consumer welfare.
Keywords: Employment and Labor Force; Health Conditions and Status; Income; Insurance

Workers' Compensation and Consumption Smoothing - Bronchetti, Erin Todd (Journal of Public Economics, 2012)
This paper investigates the consumption-smoothing benefits of state workers' compensation (WC) programs. These programs are among the largest and most controversial forms of social insurance, with the putative purpose of supporting families affected by unexpected income shocks due to workplace injuries and illnesses. Using Health and Retirement Study (HRS) data for a sample of workers who have experienced a work-related, work-limiting disability, I find that a 10 increase in WC benefit generosity offsets the drop in household consumption upon injury by 3 to 5 . Moreover, my estimates imply that if benefits were very low, the drop in consumption upon injury would be in the range of 30 . A model adapted from the literature on optimal social insurance yields a formula for the optimal level of WC benefits, which depends on empirical estimates of the consumption-smoothing parameter. My calculations suggest that current WC benefit levels are somewhat higher than optimal.
Keywords: Adult children; Consumption and Savings; Disabilities; Employment and Labor Force; Health Conditions and Status; Public Policy; Women and Minorities

Cognition and Economic Outcomes - John J McArdle; James P Smith; Robert J. Willis (Explorations in the Economics of Aging, 2011)
Keywords: Health Conditions and Status

Cognitive Aging and Human Capital - John J McArdle; Robert J. Willis (University of Michigan, 2011)
Keywords: Health Conditions and Status; Net Worth and Assets

Compression of morbidity and the labour supply of older people - Romeu Gordo, Laura (Applied Economics, 2011)
This article tests whether there is evidence of compression of morbidity using Health and Retirement Study (HRS) data and analyses the effects of this on the labour supply of older people. We find younger cohorts to suffer less from functional problems than older cohorts at given ages. Furthermore, we observe that instrumentalized disability has a negative effect on labour force participation. According to the cohort analysis and the multivariate analysis, it can be concluded that individuals will be able to work longer because of the delay in the onset of disability problems.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Methodology; Public Policy

Consumption and Differential Mortality - Michael D Hurd; Susann Rohwedder (Michigan Retirement and Disability Research Center Project, 2011)
It is well-established that differential mortality according to wealth or income introduces bias into age profiles of these variables when estimated on cross-sectional or synthetic cohort data. However, little is known about whether this association is also found with consumption, and if so, how strong this association is. In this paper we use panel data on total household spending from the Health and Retirement Study (HRS) and its supplemental study, the Consumption and Activities Mail Survey (CAMS), to estimate differences in consumption by survival status to the next survey wave. We quantify the bias in age profiles of consumption that results from differential mortality when estimating the age profiles on cross-sectional data or on synthetic cohort data. We find that the bias is smaller than that found for wealth or income.
Keywords: Consumption and Savings; Demographics; Health Conditions and Status; Methodology

The effect of late-life debt use on retirement decisions - Mann, Allison (Social Science Research, 2011)
This paper examines parallel shifts in late life debt use and retirement behaviors. After discussing the conceptual linkages between credit and labor markets, I use data from the 1992 to 2008 waves of the Health and Retirement Study to examine the temporal patterning of retirement and debt behaviors. I rely on the longitudinal structure of the data to estimate the effects of debt accumulation on retirement behaviors, using alternative specifications to identify treatment and control groups. The findings suggest that debt accumulation in later life has a significant effect on decisions to remain in the workforce in later years. PUBLICATION ABSTRACT
Keywords: Consumption and Savings; Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction

The effect of modifiable risk factors on activity limitation and limitation-free life expectancy among late midlife adults - Kenzie Latham (Sociology, 2011)
Activity limitation significantly predicts subsequent participation restriction onset, institutionalization, and early mortality. Modifiable risk factors (MRFs) (i.e., physical activity, body mass index, and smoking status) are strong and consistent predictors of activity limitation and participation restriction. This research explores the role of MRFs on activity limitation transitions (onset and recovery) among a late midlife cohort. Additionally, this research examines the influence of MRFs on activity limitation transitions across key social statuses (i.e., gender, race/ethnicity, and educational attainment). Activity limitation is broken into two categories: act limitation and task limitation. This research examines both act limitation and task limitation as separate stages of the Participation Restriction Pathway (PRP). Act limitation is measured using mobility limitation measures such as difficulty walking and climbing stairs, while task limitation is measured using Activities of Daily Living (ADL) measures (e.g., difficulty bathing, getting in and out of bed, or dressing). Additionally, positive changes in MRFs were explored as outcome measures. Utilizing Waves 2-8 (1994-2006) of the Health and Retirement Study (HRS), discrete-time event history models with multiple competing events was estimated using multinomial logistic regression. The results demonstrate the complex relationship between activity limitation transitions and MRFs as well as complicated links between MRFs and socio-demographic characteristics. In regards to activity limitation onset, the role of MRFs was not consistent for gender, race/ethnicity, and education. Unexpectedly, MRFs had little influence on the relationship between gender, race/ethnicity, and education and activity limitation recovery, which underscores the importance of non-modifiable risk factors. The predictors of a positive change in MRFs varied by outcome and the findings support the need for a greater understanding of factors shaping health promotion. The results highlight the need for further research, and they emphasize the need for functional health promotion within a structural framework.
Keywords: Demographics; Health Conditions and Status; Public Policy; Risk Taking

Essays in Labor Economics - McFall, Brooke Helppie (University of Michigan, 2011)
This dissertation is composed of two essays, both which use data from original survey projects to examine issues related to work choice. The first essay examines the labor supply effects of the wealth losses during the stock market crash of 2008 and 2009. A life-cycle model incorporating both consumption and retirement timing implies that exogenous wealth losses should delay optimal retirement timing. Using data from the Cognitive Economics Study and the Health and Retirement Study, this essay quantifies the wealth losses suffered by older Americans in terms of the additional length of time they would have to work to maintain the pre-crash consumption plan implied by their wealth holdings and expected retirement timing. Using these measures, Tobit regressions and a novel method for reducing the impact of error-ridden observations are used to examine the relationship between this measure of wealth loss and retirement planning. Several potential sources of heterogeneity in individuals' reactions to the crash are also examined. Results imply that wealth losses of 2008 and 2009 are associated with an increase in planned retirement age on the order of a few weeks to a few months for the average older American, but up to several months for some segments of the population. These results are consistent with results of recent studies and the life-cycle model, but stand in contrast to other examinations of wealth shocks on the general population of older Americans. The second essay is a product of the Job Seekers Study. The essay extends Mincer's seminal theory of family migration to allow couples to adjust to migration constraints by living apart, and examine the ways in which new PhD economists adjust to migration constraints imposed on them by their spouses or partners. Both the impact of migration constraints on job outcomes and the impact of job considerations on relationship outcomes are analyzed. The essay finds that migration constraints result in small costs in terms of job outcomes, relative to many existing studies, and that adjustment through living apart is common. These results imply that existing studies may overestimate the job impact of migration constraints.
Keywords: Health Conditions and Status; Methodology; Net Worth and Assets; Public Policy; Retirement Planning and Satisfaction

Essays on health, the process of aging, and family context - Rachel Margolis (University of Pennsylvania, 2011)
It is well-established that there is a large degree of stratification in health and well-being by socioeconomic status (SES), however the mechanisms are not well understood. I examine two factors thought to contribute to differences in health by socioeconomic status--early childhood morbidity and health behaviors. In Chapter 2, I examine whether morbidity in early and later childhood is associated with risk factors for cardiovascular disease among Guatemalan adults who experienced high levels of morbidity in childhood. I find that most types of childhood morbidity are associated with poorer adult health, independent of other measured factors, consistent with most research on this topic. However, diarrhea! disease in later childhood was associated with lower levels of some risk factors, as measured by triglycerides and plasma glucose, similar to emerging research on the importance of early life immunity. In Chapters 3 and 4, I focus on health behaviors and analyze the predictors of changes in smoking and physical activity in middle age, two health behaviors which are important for preventing and managing chronic illness and maintaining health. For these chapters, I use the Health and Retirement Study (HRS), a panel study of health and aging in the United States. In Chapter 3, I focus on differences by educational attainment in healthy behavior changes and adherence to these changes once initiated. I find that while the more-educated are the least likely to smoke in middle age and the most likely to quit overall, there are no differences by education in smoking cessation after diagnosis or adherence to smoking cessation. For physical activity, there are strong differences by educational attainment in starting physical activity overall, starting after diagnosis, and adherence. Future research should try to better understand the barriers to physical activity among those with low education. Lastly, in Chapter 4, I focus on health behaviors and health behavior changes by partnership status, partner's characteristics, and partnership transitions. Understanding the family context of healthy lifestyle changes is important to understand social patterns in health.
Keywords: Adult children; Demographics; Health Conditions and Status; Other

The gender gap in depressive symptoms among elders in the United States and Japan: Social support, coresidence and somatic health as mediating factors - Andrew D. Tiedt (Fordham University, 2011)
Cross-national research on gender and aging has discussed a persistent gender gap in depressive symptoms among elders, indicating that women report more frequent symptoms than men. In light of recent attention given to both depression and elder care issues in a global context, this dissertation examined the prevalence of depressive symptoms among elder men and women in the United States and Japan. Both nations are facing complications related to aging populations and have similar economic foundations, educational systems and representative governments. Yet the cultural underpinnings of household arrangements and family support obligations are distinct. The analyses used two waves of the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) and the Health and Retirement Study (HRS) to analyze the conditions resulting in the expression of depressive symptoms. One prominent cultural difference between nations is the persistence of intergenerational coresidence among elders and younger generations in Japan, despite more recent shifts in preference towards independent living. This dissertation posited that changing attitudes concerning filial obligations would result in more frequent depressive symptoms among Japanese women due to increased instances of conflict between coresiding elder women and daughters-in-law. Next, the dissertation posited reductions in the gender gap in depressive symptoms over time due to elder men transitioning to retirement, widowhood and disability. The analyses revealed that household relationships were more prominent as predictors of depressive symptoms in Japan than the United States. This was attributed to the persistence of filial piety. There was also evidence of the increased importance of gender in terms of late life transitions such as marital dissolution in Japan, while there was less variation in the correlates of depressive symptoms by gender in the United States. Coresidence proved to be both a buffer and aggravator of depressive symptoms among Japanese women, while coresidence was likely to buffer male mental health in either nation. However, there was evidence that living with children and receiving instrumental support exacerbated depressive symptoms among American men. These findings suggest the importance of within-gender as well as between-gender analytical approaches in order to interpret the role of culture in influencing contemporary family support relationships.
Keywords: Cross-National; Demographics; Health Conditions and Status; Healthcare; Methodology

How Do Subjective Mortality Beliefs Affect the Value of Social Security and the Optimal Claiming Age - Wei Sun; Anthony Webb (Center for Retirement Research at Boston College Working Papers, 2011)
Households that delay claiming Social Security are, in effect, making additional purchases of the Social Security annuity. Theoretical calculations show the delayed claiming is optimal, even for high mortality households. Yet most claim well before the theoretically optimal age. This paper investigates whether subjective mortality beliefs contribute to the prevalence of early claiming. The value of delay depends not only on life expectancy, but also on the degree of uncertainty surrounding the age of death. Using data from the Health and Retirement Study, we show that women approaching retirement understate their probabilities of surviving to age 75 by an average of 10 percentage points, whereas men's forecasts are, on average, correct. But both men and women exhibit greater confidence in their ability to forecast their age of death, relative to the predictions of life tables. But these subjective mortality beliefs have little effect on the value of Social Security or the optimal claim age, and cannot explain the prevalence of early claiming. We also find that self-assessed survival probabilities do not predict survival after controlling for health and socio-economic status, indicating a potential for medical underwriting to reduce adverse selection in the annuity market.
Keywords: Expectations; Health Conditions and Status; Public Policy; Retirement Planning and Satisfaction; Social Security