Essays in aging, taxation, and residential location - Martin P. Farnham (University of Michigan, 2006)
In the first paper of this dissertation, I use the panel Health and Retirement Study (HRS) and a national panel of local-level fiscal data to test a lifecycle variant of the Tiebout model. I test whether moves by empty-nest households---presumed to be out of fiscal equilibrium---yield fiscal realignments in the expected direction. I find that cross-state, empty-nest movers experience large fiscal gains in the form of reduced exposure to local school spending and property taxes relative to non-movers and non-empty-nest movers. By contrast, local empty-nest movers experience little fiscal adjustment. These findings suggest that while fiscally motivated households seek adjustment through residential mobility, their ability to adjust through local moves is constrained.In the second paper, I seek to explain why fiscal sorting is weaker for within-state movers. Using data from the first paper, I verify that cross-state empty-nest movers reduce their exposure to state income and sales taxes. In combination with the findings in the first paper, this suggests that cross-state empty-nest movers experience large fiscal gains from relocation. I exploit variation in state fiscal institutions that limit local fiscal discretion and find that school finance equalization is associated with weaker fiscal adjustment by within-state movers. Controlling for centralizing state fiscal institutions and non-fiscal impediments to Tiebout sorting, I identify significant fiscal adjustment by within-state empty-nest movers.In the third paper, I investigate the effect of taxation of homeowner capital gains on residential mobility. I estimate hazard models of homeownership spells using data from the American Housing Survey for 1989-2003. I exploit a quasi-experiment presented by the Taxpayer Relief Act of 1997 (TRA97), which significantly increased exemptions from taxation of homeowner capital gains. I compare move-out hazards for households subject to the capital gains tax prior to TRA97 to move-out hazards for exempt households and compare the mobility response by these groups to implementation of TRA97. I find that move-out hazards are declining in accumulated capital gains for households subject the capital gains tax prior to TRA97. I find evidence of housing lock-in for households under age 55 and non-tax-exempt households over age 55.
Keywords: Demographics; Health Conditions and Status; Housing; Public Policy

Essays on Health and Household Finances - Salm, Martin (Duke University, 2006)
This dissertation consists of three essays on the economics of health and household finances. The first essay investigates how subjective mortality expectations and heterogeneity in time and risk preferences affect the consumption and saving behaviors of the elderly. This study uses data on information about preferences and subjective mortality expectations from the Health and Retirement Study merged with detailed consumption data from two waves of the Consumption and Activities Mail Survey. The main results are: (1) consumption and saving choices vary with subjective mortality rates and reported time and risk preferences in a way that is consistent with the life cycle model; and (2) there is substantial heterogeneity in the estimated time discount rates and risk aversion parameters. The second essay examines the effect of job loss on health for near elderly employees. It uses longitudinal data from the Health and Retirement Study. Job loss is a major cause of economic insecurity for working age individuals, and can cause a reduction in income and loss of health insurance. To control for possible reverse causality, this study focuses on people who were laid off for an exogenous reason - the closure of their previous employers' business. This study finds no causal effect of exogenous job loss on various measures of health, which suggests that poor health of the unemployed can be explained by reverse causality. Instrumental variables regressions are used to estimate the effect of loss of health insurance, loss of income, and re-employment on health, and again there are no statistically significant effects. The third essay examines the welfare effects of tax subsidies for insurance premiums in a model of an insurance market with private information. This study finds that any second-best equilibrium can be achieved for some rate of a proportional premium subsidy. These second-best outcomes can typically not be achieved in a private insurance market without subsidies. This result suggests that subsidies for health insurance contributions, such as the tax deduction for employers' health insurance contribution in the United States, can mitigate the effects of adverse selection in health insurance markets.
Keywords: Health Conditions and Status; Net Worth and Assets

Essays on Retirement Economics - Eberhardt, Bjorn (The University of Wisconsin - Milwaukee, 2006)
In the last thirty years, research on the economics of retirement has become increasingly important. Understanding the determinants of the retirement decision is a prerequisite to assessing the impact of public insurance programs or private pension schemes on labor force participation. Given the current uncertainties about Social Security's and Medicare's long-run financial sustainability, increasing labor force participation of the elderly would be a potential way to mitigate these uncertainties. The first chapter of this dissertation reviews the literature on the retirement decision for the last 30 years and summarizes the conclusions reached in this field so far. In the second chapter, the impact of self-rated survival probabilities on the decision to retire is investigated. It is shown that a simple life-cycle model without uncertainty predicts that higher life expectancies should also lead to later retirement. Using data from the Health and Retirement Study, it is found that individual beliefs about the chance of surviving until age 85 can explain part of the variation in retirement ages. Those respondents with below-average beliefs about life expectancies also retire earlier than other respondents, even when controlling for the current health status. The third essay studies the determinants of retiree well-being over time. Previous research has almost exclusively focussed on the economic well-being of retirees. However, non-economic variables may play an important role for the subjective well-being as well. Given that many public policies are aimed at increasing the well-being of individuals, it is important to understand the relative importance of economic and non-economic variables to predict how individual's well-being would respond to such policies. Previous research has mostly relied on cross-sectional data for this analysis, and hence, the contribution of this paper is to increase our understanding in this area by adding a time dimension and study how the well-being of retirees changes over time. The findings confirm the importance of the voluntariness of retirement, as found in earlier studies, and it is also found that on average retiree well-being increases with the length of retirement.
Keywords: Employment and Labor Force; Expectations; Health Conditions and Status; Healthcare

Gender, the Marital Life Course, and Cardiovascular Disease in Late Midlife - Zhang, Zhenmei; Mark D Hayward (Journal of Marriage and Family, 2006)
Drawing on 5 waves of the Health and Retirement Study, we examine the influence of the marital life course on the prevalence and incidence of cardiovascular disease among 9,434 middle-aged individuals. Results show that compared to continuously married persons, both men and women with a marital loss have significantly higher prevalence of cardiovascular disease at baseline. Men and women, however, differ in the effects of marital loss on the incidence of cardiovascular disease over the course of the study. Women with a marital loss have a higher risk of cardiovascular disease in late midlife compared to continuously married women, whereas marital loss is not associated with men's risk of cardiovascular disease. Emotional distress and socioeconomic status account for the higher risk of cardiovascular disease among divorced women.
Keywords: Adult children; Health Conditions and Status

Health Insurance Coverage and the Risk of Decline in Overall Health and Death Among the Near Elderly, 1992-2002 - David W. Baker; Joseph J Sudano; Durazo-Arvizu, Ramon; Joseph Feinglass; Whitney P. Witt; Jason A. Thompson (Medical Care, 2006)
Background: Although individuals' health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time. . Objective: We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death from 1992 to 2002, accounting for changes in self-reported overall health and insurance coverage. .Methods: We analyzed data from the Health and Retirement study, a prospective cohort study of a national sample of community-dwelling adults age 51-61 years old at baseline. Major decline in self-reported overall health and mortality was determined at 2-year intervals. . Results: People who were uninsured at baseline had a 35 (95 confidence interval CI 12-62 ) higher risk-adjusted mortality from 1992 to 2002 compared with those with private insurance. However, when we analyzed outcomes over 2-year intervals, individuals who were uninsured at the start of each interval were more likely to have a major decline in their overall health (pooled adjusted relative risk 1.43, 95 CI 1.28-1.63), but they were equally likely to die (pooled adjusted relative risk 0.96, 95 CI 0.73-1.27). Of the 1512 people who were uninsured at baseline, 220 (14.6 ) died; of those who died, only 70 (31.8 ) were still uninsured at the HRS inter-view prior to death. Conclusions: Death does not appear to be a short-term consequence of being uninsured. Instead, higher long-term mortality among the uninsured results from erosion in this population's health status over time and the attendant higher mortality associated with this. Most deaths among the uninsured occur after individuals have gained either public or private health insurance.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Methodology; Other

His and Her Marriage Today: The impact of wives' employment on husbands' later mid-life health - Kristen W Springer (The University of Wisconsin - Madison, 2006)
Marriage is a highly gendered institution with expectations, norms, and resources organized through gender relations. The short-lived, though idealized, 1950s' notion of the "male breadwinner" solidified men's power in marriage through economic contributions from paid employment. However, the last several decades have witnessed an explosion of wives entering the labor market, all but demolishing the reality of the male breadwinner. This dissertation situates itself in this historical context to explore how wives' employment affects husbands' health. By combining gender literature on the breadwinner role with health inequalities literature, this dissertation utilizes feminist theories to contextualize men's health while at the same time using health as a heuristic to examine gender inequality and gender relations in marriage. I analyze longitudinal data on married couples from the Health and Retirement Study (HRS) to find strong evidence that a wife's employment impacts a husband's health only when he fails to achieve the normative prescription of the family breadwinner---supporting what I've termed the changing gendered-norms model. I found no support for the predominant sociological explanation that a wife's employment harms a husband's health because it limits her time available for caregiving. The starving hearts model which posits ill health effects of the social and financial burden associated with breadwinning also failed to explain the relationship between wives' employment and husbands' health. Further exploration of mechanisms driving the changing gendered-norms model did not support standard marital relations explanations including the economic resource mechanism and the marital dissatisfaction mechanism. In other words, husbands' health is not harmed because high earning wives exercise power in marital decisions nor is husbands' health harmed because economically dependent husbands are dissatisfied with their marriages. Rather, the results indicate that a husband's economic dependency adversely impacts his health through a masculinity threat resulting from having a primary breadwinning wife. These results underscore that gender inequality and ideological norms that privilege men are the sources of husbands' ill health associated with wives' employment. Social policies designed to dismantle the male breadwinner ideology and support combining home with work could improve women's social status while enhancing men's health.
Keywords: Adult children; Demographics; Health Conditions and Status; Methodology; Women and Minorities

How Secure Are Retirement Nest Eggs? - Richard W. Johnson; Mermin, Gordon B.T.; Cori E. Uccello (Boston College, Center for Retirement Research, 2006)
Life s uncertainties can upend the best-laid retirement plans. Health can fail as people grow older, or their spouses can become ill. Older people can lose their jobs, and often have trouble finding new ones. Marriages can end in widowhood or divorce. Health, employment, and marital shocks near retirement can have serious financial repercussions, raising out-of-pocket medical spending, reducing earnings, disrupting retirement saving, and forcing people to dip prematurely into their nest eggs. This brief examines different types of negative events that can strike near retirement. It reports the incidence of widowhood, divorce, job layoffs, disability, and various medical conditions over a 10-year period, and estimates their impact on household wealth. Data come from the Health and Retirement Study (HRS), a nationally representative survey of older Americans conducted by the University of Michigan for the National Institute on Aging. The survey interviewed a large sample of non-institutionalized adults ages 51 to 61 in 1992 and re-interviewed them every other year. The analysis uses data through 2002, the most recent year available. The results show that many people in their 50s and 60s experience negative shocks that threaten retirement security. Job layoffs, divorce, and the onset of work disabilities near retirement substantially erode retirement savings. The findings highlight the limitations of the safety net when things go wrong in late midlife.
Keywords: Adult children; Consumption and Savings; Health Conditions and Status; Net Worth and Assets

The Impact of Age and Health on Vehicle Choices among Elders - Hyungsoo Kim; Jinkook Lee; Kim, Doh-Khul (Journal of Family and Economic Issues, 2006)
We examine older Americans choice of vehicle types and the impact of age and health status on this choice. Using the 1998 and 2000 Health and Retirement Study (HRS) and the 2001 HRS Consumption and Activities Mail Survey (CAMS), we estimate a multinomial logit model of older Americans choice of vehicle types. We find that both age and health status influence the type of vehicle purchased or leased. Compared to Americans aged 50 59, those aged 70 or older prefer passenger cars to trucks and sport utility vehicles (SUVs). We also find that elders with health problems are more likely to prefer SUVs to passenger cars than those without health problems.
Keywords: Consumption and Savings; Health Conditions and Status

The Impact of Late-Career Job Loss on Myocardial Infarction and Stroke: A 10-year follow-up using the Health and Retirement Survey - William T Gallo; Teng, H.M.; Tracy Falba; Stanislav V Kasl; Krumholz, H.V.; Elizabeth H Bradley (Occupational and Environmental Medicine, 2006)
OBJECTIVE: Involuntary job loss is a major life event associated with social, economic, behavioural, and health outcomes, for which older workers are elevated risk. Our aim in this study was to assess the 10-year risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers over 50 years of age. METHODS: Analyzing data from the nationally representative U.S. Health and Retirement Survey (HRS), we used Cox proportional hazards analysis to estimate whether workers who suffered involuntary job loss were at higher risk for subsequent MI and stroke than individuals who continued to work. Our sample included 4,301 individuals who were employed at the 1992 study baseline. RESULTS: Over the 10-year study frame, 582 individuals (13.5 of the sample) experienced involuntary job loss. After controlling for established predictors of our outcomes, we found that displaced workers had a more than two-fold increase in the risk of subsequent MI (Hazard ratio HR = 2.48; 95 Confidence Interval CI = 1.49, 4.14) and stroke (HR = 2.43; CI = 1.18, 4.98) relative to working persons. CONCLUSION: Our results suggest that the true costs of late-career unemployment exceed financial deprivation, and include substantial health consequences. Physicians who treat individuals who lose jobs as they near retirement should consider the loss of employment a potential risk factor for adverse vascular health changes. Policy makers and program planners should also be aware of the risks of job loss, so that programmatic interventions can be designed and implemented to ease the multiple burdens of joblessness.
Keywords: Employment and Labor Force; Health Conditions and Status

Incidence and Frequency of Falling Accidents among Persons With and Without Stroke: Health and Retirement Study survey 2002 - A. A. Divani; Hoonjan, A.; Nasar, A.; Dunbar, S.; Hesselbrig, J. (Stroke, 2006)
Keywords: Health Conditions and Status

Marital History and the Burden of Cardiovascular Disease in Midlife - Zhang, Zhenmei (The Gerontologist, 2006)
This study examines the effects of marital history on the burden of cardiovascular disease in midlife. With use of data from the 1992 Health and Retirement Study, a series of nested logistic regression models was used to estimate the association between marital history and the likelihood of cardiovascular disease. Results suggest that, in midlife, the continuously married and the never married are among the healthiest in cardiovascular outcomes. People with multiple marital losses are the most vulnerable group. People with multiple marital losses have a higher likelihood of cardiovascular disease and will need significant formal and informal care as they advance into old age.
Keywords: Adult children; Health Conditions and Status

Marriage in Later Life: The Relationship between Marital Quality, Health, and Divorce - Jennifer R. Bulanda (Bowling Green State University, 2006)
Keywords: Adult children; Health Conditions and Status

Military Service and (Dis)Continuity in the Life Course: Evidence on Disadvantage and Mortality from the Health and Retirement Study and the Study of Assets and Health Dynamics Among the Oldest Old - Andrew S London; Janet M Wilmoth (Research on Aging, 2006)
This study uses a life-course framework and data from the Health and Retirement Study and the Study of Assets and Health Dynamics Among the Oldest-Old to examine three hypotheses related to (dis)continuity in the effects of early-life disadvantage (African American race and low paternal education) and military service on later-life mortality. Specifically, the authors consider whether military service (and age at enlistment) mediates or moderates the effects of early-life disadvantage on later-life mortality and whether mid- to late-life marital status, socioeconomic status, health status, and health behaviors mediate the effects of military service on mortality. The authors find very little evidence to support the notion that any mortality benefits accrue to men as a consequence of military service overall or enlistment at any particular age. Most of the evidence is consistent with life-course disruption and continuity of disadvantage interpretations.
Keywords: Demographics; Event History/Life Cycle; Health Conditions and Status

Older Women's Health and Its Impact on Wealth - Hyungsoo Kim (Journal of Women and Aging, 2006)
Keywords: Adult children; Health Conditions and Status; Net Worth and Assets

Pain, Depression, and Fatigue in Community-Dwelling Adults With and Without a History of Cancer - Reyes-Gibby, Cielito C.; Aday, Lu Ann; Anderson, Karen O.; Mendoza, Tito R.; Cleeland, Charles S. (Journal of Pain and Symptom Management, 2006)
The State of the Science Report by the National Cancer Institute on Symptom Management in Cancer identified gaps in understanding the epidemiology of pain, depression, and fatigue, and called for studies that will identify the extent of risk for these symptoms among those with cancer relative to other populations. Using year 2000 data from the Health and Retirement Study, a survey of a nationally representative sample of adults aged andgt;/=50, we evaluated whether respondents with a history of cancer had excess risk for pain, depression, and fatigue compared to those without a history of cancer. We also compared clustering/co-occurrence of symptoms. Controlling for the confounding effects of comorbidities, sociodemographic, and access to care factors, respondents with a history of cancer had higher risk for fatigue (OR=1.45; 95 CI=1.29,1.63), depression (OR=1.21; 95 CI=1.06,1.37), and pain (OR=1.15; 95 CI=1.03,1.28). Symptom clusters were also more prevalent among those with a history of cancer (Pandlt;0.001), with the pain-depression-fatigue cluster as most prevalent.
Keywords: Health Conditions and Status; Risk Taking

Parent Care and the Stress Process: Findings from panel data - Amirkhanyan, Anna A.; Douglas A. Wolf (The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 2006)
OBJECTIVE: The purpose of this study was to test with panel data an extended model of the stress process recognizing the separate effects of a parent's need for care and an adult child's caring activities. Methods. Using data from the 1996, 1998, and 2000 waves of the Health and Retirement Study, we estimated nonlinear mixed models of mental health outcomes. We assessed mental health for separate samples of 3,350 men and 3,659 women by using an 8-item scale of depressive symptoms. We also explored the sensitivity of results to alternative measures and model specifications. RESULT: . We found that female, but not male, caregivers whose parents needed care exhibited adverse mental health consequences. However, we found that, generally, both male and female noncaregivers whose parents needed care were more likely to report symptoms of depression than were noncaregivers without disabled parents. Additional findings suggest that the stress process is still more complex among married couples. Discussion. This study distinguishes the outcomes of parental care needs from those attributable to caregiving activities. Adverse psychological outcomes appear to be dispersed throughout the family. To focus narrowly on active caregivers is to underestimate the social burdens of disability at older ages.
Keywords: Health Conditions and Status; Healthcare

The Persistence of Depressive Symptoms in Older Workers Who Experience Involuntary Job Loss: Results from the Health and Retirement Study - William T Gallo; Elizabeth H Bradley; J. A. Dubin; Richard N Jones; Tracy Falba; Teng, H.M.; Stanislav V Kasl (Journals of Gerontology, Series B: Psychological and Social Sciences, 2006)
Objectives. The purpose of this study was to investigate the association between involuntary job loss among workers nearing retirement and long-term changes in depressive symptoms. Methods. Analyzing data from the first four waves (1992 1998) of the Health and Retirement Survey, we used longitudinal multiple regression in order to assess whether involuntary job loss between Wave 1 and Wave 2 was associated with depressive symptoms at Wave 3 and Wave 4. The study sample included 231 workers who had experienced job loss in the Wave 1 Wave 2 interval and a comparison group of 3,324 nondisplaced individuals. We analyzed the effect of job loss on depressive symptoms both in the full study sample and in subsamples determined by wealth. Results. Among individuals with below median net worth, Wave 1 Wave 2 involuntary job loss was associated with increased depressive symptoms at Wave 3 and Wave 4. We found no effect of involuntary job loss for high net worth individuals at the later survey waves. Discussion. Our findings identify older workers with limited wealth as an important group for which the potential effect of involuntary job separation in the years preceding retirement is ongoing (enduring) adverse mental health.
Keywords: Employment and Labor Force; Health Conditions and Status; Net Worth and Assets

Population Impact of Arthritis on Disability in Older Adults - Song, Jing; Rowland W Chang; Dorothy D Dunlop (Arthritis and Rheumatism, 2006)
Objective. Disability threatens the independence of older adults and has large economic and societal costs. This article examines the population impact of arthritis on disability incidence among older Americans. Methods. The present study used longitudinal data (1998 2000) from the Health and Retirement Study, a national probability sample of elderly Americans. Disability was defined by the inability to perform basic activities of daily living (ADL). A total of 7,758 participants ages 65 years with no ADL disability at baseline were included in the analyses. Multiple logistic regression was used to measure the impact of baseline arthritis (self reported) on incidence of subsequent ADL disability after controlling for baseline differences in demographics, health factors, health behaviors, and medical access. Results. Older adults who had baseline arthritis had a substantially higher incidence of ADL disability compared with those without arthritis (9.3 versus 4.5 ). The strong relationship of arthritis and ADL disability was partially explained by demographic, health, behavioral, and medical access factors. However, even after adjusting for all other risk factors, arthritis remained as an independent and significant predictor for developing ADL disability (adjusted odds ratio 1.5, 95 confidence interval 1.2 1.8). Almost 1 in every 4 new cases of ADL disability was due to arthritis (adjusted population attributable fraction: 23.7 ). Conclusion. The high frequency of incident ADL disability attributable to arthritis points to the importance of intervention programs that address the entire spectrum of health and functional problems in persons with arthritis to prevent disability.
Keywords: Disabilities; Health Conditions and Status; Methodology

A Profile of Frail Older Americans and their Caregivers - Joshua M Wiener; Richard W. Johnson (Washington, DC, The Urban Institute, 2006)
Keywords: Health Conditions and Status; Healthcare

The Role of Conventional Retirement Age in Retirement Decisions - Charles Brown (The University of Michigan, Michigan Retirement Research Center, 2006)
Existing research on retirement behavior tends to ignore conventional or focal or usual retirement ages in the model and estimation, and then ask whether a model which takes no direct account of such conventions can account for the observed spikes in the retirement hazard at age 62 and 65. This paper, in contrast, focuses on a direct measure of usual retirement age, based on a question that has been included in each wave of the Health and Retirement Study HRS). Using actual survey responses has several advantages: it identifies respondents who say that there is no usual retirement age for workers like them; it distinguishes between those who regard 62 and those who regard 65 as the relevant age; and it identifies the not insignificant number of workers for whom the usual age is neither 62 nor 65. There is little evidence that workers regard 63, the age at which COBRA coverage could provide a bridge to Medicare eligibility, as conventional, or that those affected by the increase in the age of eligibility for full retirement benefits under Social Security have adopted 66 or 67 as a focal retirement age. Following Wave I HRS respondents for six additional waves (12 years) so that their actual retirement can be observed shows that the actual retirement hazard is substantially higher at (and around) the age that workers identified in Wave I as the usual retirement age for workers like them. This is true even when we control for actual age at each wave, and for baseline values of earnings, wealth, health, and marital status. The finding that workers are more likely to retire at a particular age if they regard that age as the usual retirement age for workers like them suggests that the direct measures of the usual age may be useful in more formal models of the retirement process. In a world where some workers understand the incentives they face and respond appropriately, but others are poorly informed and overwhelmed by the choices they face, the usual retirement age may be a starting point for modeling the behavior of the latter group of workers.
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction

Self-Assessed Retirement Outcomes: Determinants and Pathways - Susann Rohwedder (The University of Michigan, Michigan Retirement Research Center, 2006)
There is increasing interest among policy makers in measuring well-being in ways that go beyond purely economic indicators, also with special focus on older individuals who constitute an increasing fraction of the population. However there is little consensus on which other indicators should be included. An alternative approach is to use individuals own assessments and relate these to a rich set of covariates to find what factors influence individuals own perceptions. This is the approach adopted in this paper, using data from the Health and Retirement Study (HRS). Retired respondents are asked how satisfying their retirement has turned out to be, how retirement years compare to pre-retirement years and whether they are worried about not having enough income to get by in retirement. I relate these self-assessed measures to a rich set of covariates to investigate which aspects weigh in individuals perceptions. I use the longitudinal nature of the HRS to study the pathways that lead up to the observed retirement outcomes, and to examine the persistence of the outcomes over time. Bad health, changes towards worse health, social isolation and increase in social isolation lead most significantly to lower satisfaction in retirement and a greater sense of financial insecurity in retirement. A short financial planning horizon and past shocks, like unexpected large expenses or divorce, also have a noticeable negative impact.
Keywords: Consumption and Savings; Expectations; Health Conditions and Status

Three Essays on Health and Aging - Olsho, Lauren E.W. (The University of Wisconsin - Madison, 2006)
This dissertation consists of three essays exploring the interface between health, aging, and economic behavior. The first essay explores the influence of declining health on consumption behavior with age. I solve a life-cycle model treating health as a form of human capital, and predict substantial decreases in consumption after age 50 consistent with observed declines for individuals in the Health and Retirement Study, 1992-2002. When health and consumption are complements, decreasing health capital results in falling marginal utility of consumption with age. Thus rational agents will consume at higher levels when they are younger and healthier. Since lower wealth groups generally experience more rapid health deterioration, this model largely accounts for the divergence in life-cycle consumption patterns across asset quartiles in the United States. The second essay investigates the contribution of population aging to trends in chronic conditions in the United States in the past decade and a half. I apply direct standardization to data on high cholesterol, hypertension, and obesity from the National Health and Nutrition Examination Surveys to adjust for changes in the population distribution of age, sex, race/ethnicity, poverty-income ratio, and educational status. I find that the influence of population aging, while important, is often smaller in magnitude than the effects of population shifts in other sociodemographic variables. The third essay considers the impact of a training program for health care workers in the assisted-living industry. Using repeated cross-section data on direct care workers in Wisconsin assisted-living facilities collected prior to and following the advent of the Worker Education Training and Assistance Program, and licensing data obtained from the Wisconsin Department of Health and Human Services, I investigate the effects of training on the wages of program participants and on quality of care in participating facilities, using a difference-in-differences framework with propensity scoring to control for the fact that the decision to participate in the WETA program was non-random. Worker wages increased marginally after training, but the quality of care decreased. Anecdotal evidence suggests that participating workers were systematically promoted out of the direct-care positions in which they had the most influence on quality of care.
Keywords: Health Conditions and Status; Methodology

A Three-Part Study on the Relationship Between Retirement Planning and Health - Linda Christine Albert (University of South Florida, 2006)
Researchers consistently conclude that finances and health are the two most significant factors associated with retirement decision-making and a successful retirement experience. Retirement planning is one mechanism by which individuals prepare for the retirement transition; however, retirement planning routinely emphasizes financial concerns, often to the exclusion of health or other significant aspects of retirement. Retirement planning is an increasingly relevant topic at a time when the population is aging, company-sponsored pensions and retiree benefits have diminished significantly, and reform is being sought for the long-standing social programs that have provided support for generations of older Americans. From a financial perspective, few would question the positive benefits associated with retirement planning; however, preparing for a healthy retirement is equally important. If a relationship between retirement planning and health status were to be established, Americans might find increased public and private support for individual retirement planning efforts, particularly among more vulnerable populations such as minorities and women. This dissertation explores the notion that engagement in retirement planning is associated with health status through three studies. Utilizing data from the Health and Retirement Study (HRS), the first article explores prevalence of plans for retirement among worker and retiree respondents, and compares health and other key characteristics associated with planning among the two sub-samples. The second and third articles focus on time order relationships between health status and retirement planning, with article two addressing the question of whether onset of poor health precedes planning for retirement and article three examining health status of planners versus non-planners, over time, to determine whether those who engage in retirement planning are more likely to realize better health outcomes. A brief review of the health, retirement, and retirement planning literature provides the theoretical framework for these research questions and related hypotheses. This dissertation consists of five chapters. Chapter 1 is an introduction to the retirement planning and health literature, Chapters 2-4 describe the series of three studies conducted, and Chapter 5 discusses the overall conclusions as well as future directions for research.
Keywords: Health Conditions and Status; Healthcare; Public Policy; Retirement Planning and Satisfaction

Activities of Daily Living and Cardiovascular Risk Factors' Impact on Cardiovascular Disease (CVD) and Cognitive Functioning: A three stage longitudinal model - Bozo, Ozlem (University of North Texas - Fort Worth, 2005)
The purpose of this study was to examine the longitudinal relationship of activities of daily living (ADL), cardiovascular risk factors, and cardiovascular diseases, to predict the future cognitive functioning of older Americans who are between the ages of 51 and 61 at the time of initial assessment. Three waves of the Health and Retirement Study (HRS) database between the years of 1992 and 2002 were examined with path analysis. The longitudinal hypotheses of the study were that 1) ADLs would positively predict future cognitive functioning, 2) ADLs would negatively predict future cardiovascular risk factors, 3) ADLs would negatively predict future cardiovascular diseases, 4) cardiovascular risk factors would positively predict cardiovascular diseases, 5) cardiovascular risk factors would negatively predict future cognitive functioning, 6) cardiovascular disease would negatively predict future cognitive functioning, 7) cardiovascular risk factors would mediate the relationship between ADLs and cardiovascular disease, and 8) cardiovascular disease would mediate the relationship between cardiovascular risk factors and cognitive functioning. The results of the analyses indicate that there was no effect of cardiovascular disease on cognitive functioning; however, there were significant effects of cardiovascular risk factors on cognitive functioning that ranged between -.021 and -.145. Moreover, it was found that cardiovascular risk factors mediate the relationship between ADLs and cognitive functioning, while cardiovascular disease does not. These results suggest that addressing cardiovascular risk factors may be more important than addressing existing cardiovascular disease to protect future cognitive functioning. This shows the importance of primary/secondary prevention versus tertiary interventions.
Keywords: Health Conditions and Status; Methodology; Risk Taking

The Aging, Demographics and Memory Study: Study Design and Methods - Kenneth M. Langa; Brenda L Plassman; Robert B Wallace; A. Regula Herzog; Steven G Heeringa; Mary Beth Ofstedal; James F. Burke; Gwenith G Fisher; Fultz, Nancy H.; Michael D Hurd; Guy G Potter; Willard L Rodgers; et al. (Neuroepidemiology, 2005)
Objective: We describe the design and methods of the Aging, Demographics, and Memory Study (ADAMS), a new national study that will provide data on the antecedents, prevalence, outcomes, and costs of dementia and cognitive impairment, not demented (CIND) using a unique study design based on the nationally representative Health and Retirement Study (HRS). We also illustrate potential uses of the ADAMS data and provide information to interested researchers on obtaining ADAMS and HRS data. Methods: The ADAMS is the first population-based study of dementia in the United States to include subjects from all regions of the country, while at the same time using a single standardized diagnostic protocol in a community-based sample. A sample of 856 individuals aged 70 or older who were participants in the on-going HRS received an extensive in-home clinical and neuropsychological assessment to determine a diagnosis of normal, CIND, or dementia. Within the CIND and dementia categories, subcategories (e.g., Alzheimer disease, vascular dementia) were assigned to denote the etiology of cognitive impairment. Conclusion: Linking the ADAMS dementia clinical assessment data to the wealth of available longitudinal HRS data on health, health care utilization, informal care, and economic resources and behavior, will provide a unique opportunity to study the onset of CIND and dementia in a nationally-representative population-based sample, as well as the risk factors, prevalence, outcomes, and costs of CIND and dementia.
Keywords: Health Conditions and Status; Healthcare

Associations Between Obesity and Receipt of Screening Mammography, Papanicolaou Tests, and Influenza Vaccination: Results from the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study - Truls Ostbye; Donald H. Taylor Jr.; Yancy, William S.; Katrina M. Krause (American Journal of Public Health, 2005)
Obese Americans, who receive more care for chronic diseases, may receive fewer preventive services. We evaluated the association between body mass index (BMI) and receipt of screening mammography and Papanicolaou tests among middle-aged women and the association between BMI and receipt of influenza vaccination among the elderly. We analyzed 2 datasets: the Health and Retirement Study (4439 women aged 50-61 years) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study (4045 women and 2154 men aged 70 years or more). When BMI was greater than 18.5 kg/m(2), we found an inverse dose-response relationship between BMI and receipt of screening mammography and Pap tests among White, but not Black, middle-aged women. We found a similar association between BMI and influenza vaccination among the elderly. Higher BMI was associated with less frequent receipt of preventive services among middle-aged White women and elderly White women and men. The Healthy People 2010 clinical preventive service goals remain elusive, especially for overweight and obese White persons.
Keywords: Health Conditions and Status

Black-White Disparities in Functional Decline in Older Persons: The role of cognitive function - Sandra Y. Moody-Ayers; Kala M. Mehta; Lindquist, Karla; Laura Sands; Kenneth E Covinsky (The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 2005)
Background. Black elders have a greater frequency of functional decline than do white elders. The impact of cognitive function on explaining black white disparities in functional decline has not been extensively explored. Methods. To compare the extent to which different risk domains (comorbidity, smoking, socioeconomic status (SES), self-rated health, and cognitive function) explain more frequent functional decline in black elders, we studied 779 black and 4892 white community-dwelling adults aged 70 and older from the Assets and Health Dynamics Among the Oldest Old (AHEAD), a population-based cohort study begun in 1993. Our primary outcome was worse functional status at 2 years than at baseline. We used logistic regression to compare the unadjusted with the adjusted black white odds ratios (ORs) after adjusting for each risk domain. Results. At baseline black participants aged 70 79 had higher rates of smoking, diabetes, and hypertension; lower SES; and worse cognitive function than did white participants (p .05 for all). The mean cognitive score was 15.7 in black and 21.8 in white participants (p .01). Black participants had a higher frequency of 2-year functional decline than did white participants (10.9 vs 4.7 ; OR = 2.61, 95 confidence interval CI , 1.69 4.03 adjusted for age and sex). Adjustment for comorbidity and smoking did not significantly change the black white OR, whereas self-rated health and SES accounted for about half the risk. Adjustment for cognitive function accounted for nearly all the associated decline (OR = 1.10, 95 CI, 0.67 1.79). Among participants aged 80 and over, those who were black had significantly lower risk for functional decline after adjustment for cognitive function (OR = 0.61, 95 CI, 0.38 0.96 vs OR = 1.08, 95 CI, 0.70 1.66 adjusted for age and sex only). Conclusions. Cognitive function mediated the higher frequency of functional decline among black elders. Efforts to understand cognitive function may enhance our understanding of black white disparities in health outcomes.
Keywords: Demographics; Health Conditions and Status

Comment: Broken Down by Work and Sex: How Our Health Declines - Daniel McFadden (Analyses in the Economics of Aging, 2005)
Commentary on the Case and Deaton chapter, Broken Down by Work and Sex: How Our Health Declines, Using AHEAD data for comparison.
Keywords: Health Conditions and Status; Other

Consequences and Predictors of New Health Events - James P Smith (Analyses in the Economics of Aging, 2005)
The emphasis in health research has been on understanding and disentangling the multiple ways in which socio-economic status may influence a variety of health outcomes. Consequently, much less is currently known about the impact health may have on SES. But at least for working-aged individuals, health feedbacks to labor supply, household income, and wealth may be quantitatively quite important. Therefore, one aim of this paper will be to estimate the effect of new health events on a series of subsequent outcomes that are both directly and indirectly related to SES. These outcomes will include out-of-pocket medical expenses, the intensive and extensive margins of labor supply, health insurance, and household income.
Keywords: Demographics; Health Conditions and Status

Depression and Comorbid Pain as Predictors of Disability, Employment, Insurance Status, and Health Care Costs - Emptage, Nicholas P.; Sturm, Roland; Robinson, Rebecca L. (Psychiatric Services, 2005)
OBJECTIVE: Individuals with depression commonly experience pain with unclear pathology. This study examined depression and comorbid pain and associated outcomes over six years in a nationally representative cohort of older Americans. METHODS: The Health and Retirement Study began in 1992 and follows 9,825 individuals between the ages of 50 and 61 years. The study reported here used data beginning in 1994 to contrast individuals with depression and those with depression plus comorbid pain. Regression models adjusted for differences in sociodemographic characteristics and health status. RESULTS: Baseline (1994) data were available for 8,280 participants. At baseline, 65.2 percent reported that they did not have pain or depression, 8.1 percent had depression alone, 15.5 percent had mild or moderate pain alone, 2 percent had severe pain alone, 6.6 percent had depression plus mild or moderate pain, and 2.6 percent had depression plus severe pain. Compared with the group with no pain or depression, all the groups with depression, pain, or both had greater decrements in outcomes. Groups tended to have greater decrements in outcomes as levels of pain increased. Overall, no statistically significant differences were found between the groups with depression plus pain and their corresponding groups with pain alone. Two to six years after baseline, compared with participants with depression alone, those with severe pain or depression plus severe pain were more likely to experience new functional limitations and to have higher total health care expenditures. Compared with participants with depression alone, participants with depression plus severe pain were also more likely to lose employment and private health insurance. CONCLUSIONS: Relative to depression alone, depression plus pain and pain alone (particularly severe pain) were associated with significant functional limitations and economic burdens.
Keywords: Health Conditions and Status

Depressive Symptoms of Caregiving Women in Midlife: The role of physical health. - Timothy S Killian; M Jean Turner; Rebekah Cain (Journal of Women and Aging, 2005)
This research examined the relationships between providing assistance to aging family members, caregivers' age, caregivers' perceptions of their physical health, and caregivers' depressive symptoms. Several alternative hypotheses were examined. Longitudinal data from 1,898 women from the 1992 and 2000 waves of the Health and Retirement Study (HRS) were used. Results indicate a reciprocal relationship between depression and physical health. These processes were examined using a path analysis. Although the evidence only supported one of the hypotheses, this study clearly demonstrated the importance of physical health for the psychological well-being of women in midlife.
Keywords: Health Conditions and Status; Healthcare; Women and Minorities

Diabetes and Urinary Incontinence in 50- to 90-year-old Women: A cross-sectional population-based study - Cynthia M. Lewis; Ronald M Schrader; Many, Angela; Mackay, Mary; Rebecca G Rogers (American Journal of Obstetrics and Gynecology, 2005)
Objective: The purpose of this study was to examine the association between urinary incontinence and diabetes in a large community-based population of women. Study design: The Health and Retirement Study is a large multistage area probability sample of households in the United States. Data were collected from 10,678 women aged 50 to 90 years. Dependent variables were no, mild, and severe incontinence. Independent variables consisted of demographic and health data. Diabetes was dichotomized into insulin-requiring (IRDM) and non insulin-requiring disease (NIRDM). Survey-based ordered logistic regression was used to simultaneously analyze associations between incontinence groups. Results: Urinary incontinence was reported by 22 (2319/10,678) of women. IRDM was associated with urinary incontinence (odds ratio OR 1.63; 95 CI 1.28-2.09), but NIRDM was not (OR 1.20; 95 CI 1.00-1.45). Conclusion: IRDM is independently associated with urinary incontinence in women ages 50 to 90 years, independent of patient body mass index, comorbidities, or age.
Keywords: Health Conditions and Status; Risk Taking

Do New Health Conditions Support Mortality-Air Pollution Effects? - Mary F. Evans (Journal of Environmental Economics and Management, 2005)
Epidemiological research underlying US air quality regulations documents significant associations between measures of fine particles and premature mortality. Recent studies examine potential mechanistic pathways, related to heart and lung functioning, that may contribute to the observed deaths. Our results support these pathophysiological analyses. We examine whether the onset of serious health conditions, consistent with disease pathways, is related to current and long-term exposure to particulate matter and ozone. Associations between air pollution and alternative indicators of health status are also evaluated. The 1996 wave of the Health and Retirement Study is used with a two-step estimator acknowledging limitations in our ability to measure individual exposures. The findings suggest significant current and long-term effects of particulates on new cases of heart attacks and angina, reinforcing the disease pathways identified in epidemiological studies. Long-term air pollution exposure is also a determinant of recently diagnosed chronic lung conditions and reports of shortness of breath.
Keywords: Health Conditions and Status

Do Panel Surveys Make People Sick? U.S. Arthritis Trends in the Health and Retirement Study - Sven E. Wilson; Benjamin L. Howell (Social Science and Medicine, 2005)
Researchers have long viewed large, longitudinal studies as essential for understanding chronic illness and generally superior to cross-sectional studies. In this study, we show that (1) age-specific arthritis prevalence in the longitudinal Health and Retirement Study (HRS) from the United States has risen sharply since its inception in 1992, and (2) this rise is almost surely spurious. In periods for which the data sets are comparable, we find no such increase in the crosssectional National Health Interview Survey (NHIS), the primary source for prevalence data of chronic conditions in the US. More important, the upward trend in the HRS is not internally consistent: even though prevalence in the HRS rises sharply between 1992 and 1996 for 55 56 year-olds, the prevalence for that age group plummets to its 1992 level among the new cohort added in 1998 and then rises rapidly again between 1998 and 2002. We discuss possible reasons for these discrepancies and demonstrate that they are not due to sample attrition in the HRS.
Keywords: Health Conditions and Status; Methodology

Do Seniors Understand Their Risk of Moving to a Nursing Home? - Donald H. Taylor Jr.; Ostermann, Jan; Acuff, S. Will; Truls Ostbye (Health Services Research, 2005)
Objective: To determine whether seniors understand their risk of moving to a nursing home. Data Sources: We used longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) database. AHEAD is a nationally representative survey (n=8,203) of community dwellers aged 70 years and their spouses. Study Design: We followed respondents for 5 years from the date of the first interview fielded in 1993. Our primary dependent variable was whether respondents moved to a nursing home within 5 years of baseline; self-assessed probability of moving to a nursing home within 5 years, also assessed at baseline, was the primary explanatory variable. Principal Findings: We found that seniors who believed they were more likely to move to a nursing home within 5 years were indeed more likely to do so, and that most elders overestimated their likelihood of moving to a nursing home. Conclusions: Low rates of private long-term care insurance are not plausibly a result of seniors underestimating their personal risk of moving to a nursing home; such an assumption is inherent in many strategies to plan for the future long-term care needs of the baby boom generation.
Keywords: Health Conditions and Status; Healthcare

Do Socioeconomic Mortality Differences Decrease with Rising Age? - Rasmus Hoffmann (Demographic Research, 2005)
The impact of SES on mortality is an established finding in mortality research. I examine, whether this impact decreases with age. Most research finds evidence for this decrease but it is unknown whether the decline is due to mortality selection. My data come from the US-Health and Retirement Study (HRS) and includes 9376 persons aged 59 , which are followed over 8 years. The variables allow a time varying measurement of SES, health and behavior. Event-history-analysis is applied to analyze mortality differentials. My results show that socioeconomic mortality differences are stable across ages whereas they decline clearly with decreasing health. The first finding that health rather than age is the equalizer combined with the second finding of unequally distributed health leads to the conclusion that in old age, the impact of SES is transferred to health and is stable across ages.
Keywords: Demographics; Health Conditions and Status

Documentation of Chronic Disease Measures in the Health and Retirement Study - Gwenith G Fisher; Jessica Faul; David R Weir; Robert B Wallace (Institute for Social Research, University of Michigan, 2005)
The focus of this report is on (1) self-rated overall health status and recent changes in overall health, (2) the presence of common chronic medical conditions and follow-up questions concerning treatments in all waves of the core HRS/AHEAD through 2002.
Keywords: Health Conditions and Status; Healthcare; Methodology

Documentation of Cognitive Functioning Measures in the Health and Retirement Study - Mary Beth Ofstedal; Gwenith G Fisher; A. Regula Herzog (Institute for Social Research, University of Michigan, 2005)
Keywords: Health Conditions and Status; Methodology

Does the Socioeconomic Mortality Gradient Interact with Age? Evidence from U.S. Survey Data and Danish Register Data - Rasmus Hoffmann (Rostock, Germany, Max Planck Institute for Demographic Research, 2005)
The aim of our paper is to provide an answer to the questions if and why social differences in health and mortality decrease with age. Most research confirms this decrease but the reasons for it and the role of unobserved heterogeneity are unknown. The data used for our analysis come from the US Health and Retirement Study (n=9376) and from the Danish Demographic Database (Denmark s population above age 58). They offer detailed information about SES and health information. The technique of event-history-analysis is used, and frailty models address mortality selection. A new method is developed to consider systematic difference in the change of average frailty over age between social groups. SES differentials in mortality converge with age in Denmark but not in the US. In both countries, they converge strongly with decreasing health. When controlled for health, the differences are stable across age in both countries. This means that worsening health levels social mortality differences and not increasing age. Controlling for mortality selection removes the converging pattern over age.
Keywords: Demographics; Health Conditions and Status

The Effect of Alcohol Consumption on the Earnings of Older Workers - Saffer, Henry; Dhaval, Dave (Advances in Health Economics and Health Services Research, 2005)
This study analyses the effects of alcohol consumption on the labour market outcomes of older individuals. The data set used consists of five waves of the Health and Retirement Study. The results from models with a limited number of covariates indicate that there is a wage and earnings premium associated with alcohol use. This premium progressively diminishes as more individual-level controls are added to the standard earnings function. The data set is longitudinal which allows for estimation of individual-fixed-effects specifications. These results indicate that alcohol use does not have a positive effect on earnings and wages.
Keywords: Employment and Labor Force; Health Conditions and Status

The Effect of Diabetes on Diability in Middle-Aged and Older Adults - Linda A. Wray; Mary Beth Ofstedal; Kenneth M. Langa; Caroline S Blaum (The Journals of Gerontology, Series A: Medical Sciences, 2005)
Background. Physical disability is increasingly recognized as an adverse health consequence of type 2 diabetes in older adults. We studied the effect of diabetes on disability in middle-aged and older adults to: 1) characterize the association of diabetes with physical disability in middle-aged adults, and 2) determine the extent to which the effect of diabetes is explained by related covariates in either or both age groups. Methods. We used data from two parallel national panel studies of middle-aged and older adults to study the effect of self-reported diabetes at baseline on disability 2 years later, adjusting for baseline covariates. Results. Diabetes was strongly associated with subsequent physical disability (measured by a composite variable combining activities of daily living, mobility, and strength tasks) in middle-aged and older adults. Controlling for socioeconomic characteristics and common diabetes-related and unrelated comorbidities and conditions reduced the diabetes effect substantially, but it remained a significant predictor of disability in both groups. Conclusions. Our analyses demonstrated that disability is an important diabetes-related health outcome in middle-aged and older adults that should be prevented or mitigated through appropriate diabetes management.
Keywords: Demographics; Disabilities; Health Conditions and Status

The Effect of Involuntary Job Loss on Smoking Intensity and Relapse - Tracy Falba; Teng, Hsun-Mei; Jody L Sindelar; William T Gallo (Addiction, 2005)
Aims: To assess the impact of involuntary job loss due to plant closure or layoff on relapse to smoking and smoking intensity among older workers. Design, participants, sample: Data come from the Health and Retirement Study, a nationally representative survey of older Americans aged 51-61 in 1991 followed every 2 years beginning in 1992. The 3052 participants who were working at the initial wave and had any history of smoking comprise the main sample. Methods: Primary outcomes are smoking relapse at wave 2 (1994) among baseline former smokers, and smoking quantity at wave 2 among baseline current smokers. As reported at the wave 2 follow-up, 6.8 of the sample experienced an involuntary job loss between waves 1 and 2. Findings: Older workers have over two times greater odds of relapse subsequent to involuntary job loss than those who did not. Further, those who were current smokers prior to displacement that did not obtain new employment were found to be smoking more cigarettes, on average, post-job loss. Conclusions: The stress of job loss, along with other significant changes associated with leaving one's job, which would tend to increase cigarette consumption, must outweigh the financial hardship which would tend to reduce consumption. This highlights job loss as an important health risk factor for older smokers.
Keywords: Employment and Labor Force; Health Conditions and Status

Effect of Physical Activity on Functional Status among Older Middle-Age Adults with Arthritis - Joseph Feinglass; Jason A. Thompson; Xiaoxing He; Whitney P. Witt; Rowland W Chang; David W. Baker (Arthritis Care and Research, 2005)
Objective. To determine the effect of leisure time and work-related physical activity on changes in physical functioning among 3,554 nationally representative survey respondents, ages 53 63 years in 1994, with arthritis and joint symptoms, interviewed in the Health and Retirement Study (HRS). Methods. In 1992 1994, light and vigorous exercise items were empirically categorized into recommended, insufficient, and inactive leisure time physical activity levels using data from the HRS. Leisure and work-related physical activity levels in 1994 were used to predict 1996 functional decline or improvement, controlling for baseline functional difficulties, health status, sociodemographic characteristics, and behavioral risk factors. Results. Whereas 29.7 of respondents reported functional declines in 1996, 38.6 of those with baseline difficulties in 1994 reported improvement. Compared with inactive respondents, recommended and insufficient leisure time physical activity were equally protective against functional decline (odds ratio OR 0.59 and 0.62, respectively; P 0.0001). Higher levels of physical activity were also modestly associated with functional improvement among respondents with baseline functional difficulties (OR 1.47, P 0.05 and OR 1.45, P 0.01, respectively). Work-related physical activity was not a significant predictor of decline or improvement. Conclusion. Given the high prevalence of arthritis, even modest increases in rates of lifestyle physical activity among older adults could make a substantial contribution to disability-free life expectancy.
Keywords: Health Conditions and Status

The Effect of Veteran Status on Mortality Among Older Americans and Its Pathways - Xian Li; Engel, Charles C.; Han Kang; Cowan, David (Population Research and Policy Review, 2005)
Abstract This research examines excess mortality among American veterans age 70 years or older during a two-to-three year interval from 1993/94 to the end of 1995. Using a structural hazard rate model, we analyzed data on a sample of respondents age 70 or over from the Survey of Asset and Health Dynamics among the Oldest Old (AHEAD). We found that at age 70, older veterans have a slightly higher death rate than their nonveteran counterparts, implying a mortality crossover right before this age. Such excess mortality among veterans increases considerably with age, when other factors are held equal. The direct and indirect effects of veteran status on mortality by means of physical and mental health mostly perform in opposite directions, and such effects vary greatly in magnitude and direction as a function of age. The intervening effects of physical and mental health status decrease substantially with increasing age. Many of the mechanisms inherent in the excess mortality among older veterans are not captured by variations in their health status, especially among the oldest-old. A more extensive study on this topic is urgently needed.
Keywords: Event History/Life Cycle; Health Conditions and Status

Effects of Changes in Self-Reported Vision on Cognitive, Affective and Functional Status and Living Arrangements Among the Elderly - Frank A Sloan; Ostermann, Jan; Derek S. Brown; Paul P Lee (American Journal of Ophthalmology, 2005)
PURPOSE: To study effects of changes in self-reported vision on functional status, cognition, depressive symptoms, and living arrangements. DESIGN: Longitudinal analysis of household survey data. METHODS: A total of 6234 sample persons observed in the study of Assets and Health Dynamics Among the Oldest Old (AHEAD) 1995 were followed in 1998, 2000, and 2002 or until death or sample attrition. Effects of changes in self-reported vision and other factors were assessed by means of ordinary least-squares and logistic regression with panel data methods. Main outcome measures were limitations of instrumental activities of daily living (IADLs), activities of daily living (ADLs), and other, cognition, depressive symptoms, and living arrangements. RESULTS: A decline from excellent/good vision to fair/poor near and distance vision had statistically significant effects on several IADL limitations, and some ADL and other limitations. Largest effects were for driving (OR for no limitation: 0.55, P = .003), managing money (OR: 0.61, P .001), and preparing hot meals (OR: 0.61, P .001). Onset of fair-poor near vision increased the likelihood of onset of at least one IADL (OR for no limitation: 0.71, P .01) and ADL (OR: 0.74, P = .003) limitation. Onset of legal blindness resulted in a 78 increase in the likelihood of an IADL limitation (OR for no limitation: 0.22, P .001). Effects of vision declines on cognition and depressive symptoms were statistically significant but small. Decline in vision increased the probability of nursing home residence. CONCLUSIONS: Visual impairment has major impacts on functional status. Preventing vision loss is likely to appreciably improve the functioning of elderly persons.
Keywords: Demographics; Health Conditions and Status

The Effects of Volunteering on the Physical and Mental Health of Older People - Terry Y S Lum; Lightfoot, Elizabeth (Research on Aging, 2005)
The purpose of this study is to build on the growing body of literature examining the correlations between volunteering and health among older persons. Longitudinal data from the 1993 and 2000 panels of the Asset and Health Dynamics Among the Oldest Old Study (AHEAD) were used to measure health and mental health outcomes of people over age 70 who volunteered at least 100 hours in 1993. The findings provide empirical support to earlier claims that volunteering slows the decline in self-reported health and functioning levels, slows the increase in depression levels, and improves mortality rates for those who volunteer. However, volunteering had no effect on the number of physician-diagnosed health conditions or nursing home residence rates. The findings provide support for the concept of role enhancement.
Keywords: Employment and Labor Force; Health Conditions and Status

Estimating Age Change in List Recall in Asset and Health Dynamics of the Oldest Old: Attrition bias and missing data treatment - Robert F. Kennison; Elizabeth Zelinski (Psychology and Aging, 2005)
Average change in list recall was evaluated as a function of missing data treatment (Study 1) and dropout status (Study 2) over ages 70 to 105 in Asset and Health Dynamics of the Oldest-Old data. In Study 1 the authors compared results of full-information maximum likelihood (FIML) and the multiple imputation (MI) missing-data treatments with and without independent predictors of missingness. Results showed declines in all treatments, but declines were larger for FIML and MI treatments when predictors were included in the treatment of missing data, indicating that attrition bias was reduced. In Study 2, models that included dropout status had better fits and reduced random variance compared with models without dropout status. The authors conclude that change estimates are most accurate when independent predictors of missingness are included in the treatment of missing data with either MI or FIML and when dropout effects are modeled.
Keywords: Health Conditions and Status; Methodology

Estimating Life Cycle Effects of Survival Probabilities in the Health and Retirement Study - Michael M. Perry (The University of Michigan, Michigan Retirement Research Center, 2005)
This paper attempts to confirm the life-cycle relationship that lower subjective survival probabilities should lead to less positively sloped consumption trajectories. I use the results of six waves of subjective survival probability questions in the HRS to construct an index of survival belief that exploits the panel nature of the data by summarizing all of a respondent s answers to such questions. In conjunction with constructed consumption values from the financial section of the HRS, I test the life-cycle relationship using OLS and Least-Absolute Deviation regression. I find weak evidence that the life-cycle effect of subjective survival probability is significant in a high-cognitive-ability sub-sample of the HRS. Measurement error in the constructed consumption data is problematic.
Keywords: Consumption and Savings; Event History/Life Cycle; Expectations; Health Conditions and Status

Financial Management Assistance Use by the Vulnerable Elderly - Kim, Eun-Jin (The Ohio State University, 2005)
The rapid growth of the elderly population raises concerns in the United States for older people's well-being. Effective financial management is important to the well-being of retired people since the elderly are more likely to face limited financial resources and complicated financial management tasks, such as navigating health care insurance payments and managing stocks. One way for the elderly to successfully manage their finances is to seek assistance from others. This study uses the 2000 Health and Retirement Study to examine factors affecting financial management assistance use by the elderly (individuals 65 years and older) facing difficulties managing their own finances. "Vulnerability" is suggested as a factor affecting financial management assistance use by the elderly. Vulnerability is a multidimensional concept incorporating health status, cognitive ability, and social interaction factors. The vulnerable elderly have health problems, reduced cognitive skills, and are often socially isolated due to the death of a spouse or retirement. Persons 65 years and older were found to be more vulnerable than persons younger than 65 years in terms of health status, cognitive ability, and social interaction. (n = 11,492). Since vulnerability is more prevalent among the older people, the study sample was limited to persons 65 years and older. Elderly persons reporting difficulty with financial management were studied to identify factors affecting financial management assistance use by the vulnerable elderly (n = 271). Logistic regression analysis revealed that age, presence of an IADL problem, depression, and computation ability affect older people's financial management assistance use. Elderly who are older, not depressed, and have an IADL problem and computation inability are more likely to use financial management assistance. Since depressed elderly persons are less likely to use assistance even if they have difficulties managing finances, the depressed elderly may be in a vulnerable situation with respect to effective financial management. Interventions related to financial management may improve the financial well-being of the depressed elderly. The findings of this study suggest that the factors determining older people's use of financial management assistance are physical and mental health status and cognitive ability rather than economic status.
Keywords: Health Conditions and Status; Net Worth and Assets

Health Status, Insurance, and Expenditures in the Transition from Work to Retirement - Hugo Benítez-Silva; Boz, Emine; Buchinsky, Moshe; Nichols, Joseph B.; Roy, Sharbani; Rust, John; Tristao, Ignez (ERIU Working Paper, 2005)
This paper analyzes the dynamics of health insurance coverage, health expenditures, and health status in the decade expanding from 1992 to 2002, for a cohort of older Americans. We follow 13,594 individuals interviewed in Waves 1 to 6 of the Health and Retirement Study, most of whom were born between 1930 and 1940, as they transition from work into retirement. Although this depression cohort is by and large fairly well prepared for retirement in terms of pension coverage and savings, we identify significant gaps in their health insurance coverage, especially among the most disadvantaged members of this cohort. We find that government health insurance programs particularly Medicare and Medicaid significantly reduce the number of individuals who are uninsured and the risks of large out of pocket health care costs. However, prior to retirement large numbers of these respondents were uninsured, nearly 18 at the first survey in 1992. Moreover, a much larger share, about 55 of this cohort, are transitorily uninsured, that is, they experience one or more spells, lasting from several months to several years, without health insurance coverage. We also identify a much smaller group of persistently uninsured individuals, and show that this group has significantly less wealth, and higher rates of poverty, unemployment, and health problems, disability, and higher mortality rates than the rest of the members of the cohort under study. We provide evidence that lack of health insurance coverage is correlated with reduced utilization of health care services; for example, respondents with no health insurance visit the doctor one fourth as often as those with private insurance and are also more likely to report declines in health status. We also analyze the components of out of pocket health care costs, and show that prescription drug costs constituted a rapidly rising share of the overall cost of health care during the period of analysis.
Keywords: Health Conditions and Status; Insurance

Healthy, Wealthy, and Knowing Where to Live: Trajectories of Health, Wealth, and Living Arrangements among the Oldest Old - Florian Heiss; Michael D Hurd; Axel Borsch-Supan (Analyses in the Economics of Aging, 2005)
There are many mechanisms that suggest that living arrangements and well-being derived from health and economic status are closely related. This paper investigates the joint evolution of the three conditions, using a microeconometric approach similar to what is known as vector autoregressions (VAR) in the macroeconomics literature.
Keywords: Consumption and Savings; Health Conditions and Status; Net Worth and Assets

Impact of Food Insecurity and Food Assistance Programs on Nutrition and Health Outcomes in Elders - Kim, Kirang (Cornell University, 2005)
This research examined the relationship between need and help-seeking behavior over time in elders, looking at the pattern of food insecurity and program participation, which are a part of need and help-seeking behavior. Then, it assessed how a help-seeking behavior (i.e., participation in food assistance programs) among elders in need (i.e., food insecure elders) affected multiple outcomes such as obesity, depression, and health service utilization. For addressing these research questions, secondary data analysis was done using two longitudinal data sets: Health and Retirement Study (HRS 1996, 2002) and the Asset and Health Dynamics Among the Oldest Old (AHEAD 1995, 2002). The finding on patterns of food insecurity and participation in food assistance programs over time showed that need and help-seeking behavior were changeable but the variation over time was small. The relationship between them was monotonic and increasing. Food insecurity was a useful indicator of need for participation in food assistance programs and previous experience of participation was an important indicator of help-seeking behavior. While food insecurity was a part of need for participation in food assistance programs, for health service utilization it appeared to be a barrier that makes food insecure elders be less likely to use health services. While food insecurity increased overweight and depression, participation in food assistance programs had beneficial impacts on poor health outcomes resulting from food insecurity. Food insecure elders who participated in food assistance programs were less overweight, depressed, and admitted to hospital and nursing home than those who did not participate in the programs. Findings of positive impacts on reducing or preventing obesity, depression, and admission to hospital and nursing home implies other benefits of food assistance programs such as decreased health-care expenditures and increased independence of elders, supporting further development of these programs for elders.
Keywords: Demographics; Health Conditions and Status; Healthcare; Income

The Impact of SES on Health over the Life Course - James P Smith (RAND Working Paper, 2005)
People of lower socio-economic status (SES) have much worse health outcomes (Marmot (1999), Smith (1999)). But why this is so remains under considerable debate ((Adams et al. (2003), Deaton (2003)). A central question is whether these large differences in health by such SES indicators as income or wealth largely reflect causation from SES to health. But even if SES mainly affects health, what dimensions of SES actually matter financial aspects such as income or wealth or non-financial dimensions like education?
Keywords: Demographics; Health Conditions and Status; Net Worth and Assets

Medical Diagnosis Can Induce Depressive Symptoms - Kayalli, Andrea (The American Journal of Nursing, 2005)
Researchers used the data from the Health and Retirement Study to assess symptoms of depression in those between the age of 51 and 61 who were not depressive at the beginning of the study. The state of each subject's emotions was evaluated periodically with specific attention paid to the connection between their emotions and a recent medical diagnosis.
Keywords: Health Conditions and Status; Healthcare

The Microeconomic Effect of Longevity on Savings: Evidence from the Health and Retirement Study - Reed, Edward (Department of Economics, Harvard College, 2005)
This paper seeks to address the microeconomic link between health, particularly longevity, and savings rates. Using the expansive Health and Retirement Study, a microeconomic model for savings is generated. Both ordinary least squares and two stage least squares regressions, with height as an instrument for life expectancy estimates found in the survey, show a tentative positive link between longevity and savings. In the grander scheme, these results underscore the returns to an economy from investment in health care, decreased morbidity and increased longevity.
Keywords: Consumption and Savings; Health Conditions and Status

Perceived Discrimination, Cumulative Disadvantage and the Life Course: Women's mental health in retirement/old age - Martha A. Jacob (The Gerontologist, 2005)
Keywords: Health Conditions and Status; Women and Minorities

The Relationship Between Occupational Physical Demands and Job Satisfaction: Sex, Age, Class, and Ethnoracial Group Perspectives - Suneson, Charlene Ida (University of Southern California, 2005)
Historical records show extensive patterns of involuntary removal of women and older workers from physically demanding occupations. Although most such sex- and age-based exclusion from physically demanding work is no longer legal in the United States, and although most research shows that physical activity is of benefit to people, job actions and policy considerations continue to be influenced by cultural sentiment that physically demanding work is of no interest to or inappropriate for women and older workers. What are the effects of these negative cultural influences on job satisfaction? Do they outweigh the benefits of physical activity? What are the resultant relationships between occupational physical demands and job satisfaction for women and older workers? To determine the answers, the contributions of physical demands toward job satisfaction are compared across a series of multivariate analyses on subsets of sex, age, class, and ethnoracial groups in two data sets. A physical demands variable created from U.S. Department of Labor data is used with National Survey of Families and Households (NSFH) data on those aged 19 or older, while a self-report physical effort variable is utilized with Health and Retirement Study (HRS) data on those aged 51 to 61. NSFH findings are that women and older workers have more positive physical demands-job satisfaction relationships than men and younger workers. Older men in boring jobs have more positive results than their counterparts in interesting jobs. HRS findings are that non-health limited women and men with lesser non-workplace physical activity have more positive physical demands-job satisfaction relationships than those with greater non-workplace physical activity. Occupational physical demands appear to operate primarily, although not entirely, as compensatory mechanisms in their effect on job satisfaction. They are more salient for job satisfaction when other occupational intrinsic factors are lacking, but more importantly, when there is insufficient non-workplace physical activity. Thus, it should not be assumed that physically demanding work is inappropriate for or not of interest to women and older workers.
Keywords: Employment and Labor Force; Health Conditions and Status

Retirement and Obesity among the Near Elderly - Chung, Sukyung (The University of North Carolina at Chapel Hill, 2005)
This dissertation investigates the causal effect of retirement on obesity-related health behavior. With the increasing prevalence of obesity, the health consequences of obesity are major causes of soaring health care costs. The prevalence and growth of obesity is highest among those in their fifties and sixties, close to the age of the highest retirement rate in the US. Retirement represents conspicuous changes in time availability, financial constraints, physical activity, and scope of social activity, all of which could influence the risk of obesity. In the identification of the causal effect of retirement, regression estimates from different assumptions on unobserved heterogeneity are compared. The econometric strategy takes advantage of the individual-level panel dataset with rich information on health, occupation, financial status and employment history provided by the Health and Retirement Study from 1992 to 2002. This study finds significant weight gain led by retirement and by decreasing working-hours of current workers. Retirement lowers the participation in vigorous physical activity only for the formerly physical workers and reduces total daily metabolic equivalent regardless of occupation type. Retirement reduces the consumption of food away from home but does not change the consumption of food at home nor alcohol intake. All of these health behavioral modifications caused by retirement are evident among people with lower wealth who are initially more likely to be obese and to retire at an earlier age, and among former physical workers. The overall finding of this study implies that weight gain with retirement could be largely from the loss of occupational physical demands which is not fully compensated by physical activities during the increased non-working hours. With the baby boomer population approaching retirement age, the increased risk of obesity caused by retirement could have considerable impact on the health status of older adults and the health care system. Promotion of physical activity of retirees should be a priority of public health efforts to reduce the risk of obesity and health care cost ascribed to retirement. Effective policies to enhance physical activity of retirees especially for the former physical workers with low wealth should be investigated in future research.
Keywords: Employment and Labor Force; Health Conditions and Status; Public Policy

A Slippery Slope: Essays on Income, Wealth, and the Health Gradient - Wenzlow, Audra T. (The University of Wisconsin - Madison, 2005)
The relationship between health and socioeconomic status (SES), often called the health gradient, is a complex and perplexing research puzzle. Individuals with higher incomes tend to be healthier (although at a declining rate with higher income), yet it is unclear why this is so. Here, I argue that wealth and savings, largely neglected in past empirical work, provide important insights into the health-SES relationship. An empirical model in which income and wealth are transformed using the inverse hyperbolic sine is shown to capture important variations in health throughout the income and wealth distributions for U.S. working-age adults. The three-dimensional gradient in income, wealth, and health illustrates two patterns that are investigated in the following chapters: the predominance of poor health among those with little savings, and variations in health disparities by wealth over the life cycle. Panel data from the Health and Retirement Study are used to investigate a likely mode through which wealth may have a causal effect on health among the poor: through financial constraints that limit access to health care at the time of illness. I capitalize on recent research suggesting that income and wealth do not cause the onset of certain acute illnesses, conditional on past health. Viewing unexpected costs associated with such illnesses as financial shocks, I find that approximately one quarter of the population that experiences a stroke, cancer, heart problem, or high blood pressure has insufficient liquid assets to cover typical costs of unexpected medical care. Furthermore, this study suggests that a causal relationship between lack of savings and health recovery is plausible, possibly contributing to the steep slope of the gradient about zero. In the final chapter, I test a number of hypotheses that could account for the observed life cycle pattern of declining socioeconomic disparities in health in old age. I find that poor measurement of financial resources and possible cohort, Medicare, or retirement effects, but not attrition, are likely contributors to this phenomenon. Taking into account life-cycle patterns of income receipt and wealth decumulation, I find a large health gradient in wealth among the oldest old.
Keywords: Health Conditions and Status; Income; Net Worth and Assets

Socioeconomic Differentials in Mortality and Health at the Older Ages - Eileen M. Crimmins (Genus, 2005)
Keywords: Demographics; Health Conditions and Status; Healthcare

Topics in Labor Markets, Health, and Employer-Sponsored Health Insurance - Baker, Colin Sean (Harvard University, 2005)
Three questions are examined. The first concerns the effect of minimum wage hikes on employer-sponsored health insurance. Low-skilled workers have limited access to health benefits, and a binding minimum wage can make it impossible for firms to offer coverage. I use changes in the level and bindingness of minimum wage laws during 1987-1999 to identify effects on the proportion of full-time adult workers with health insurance. An increase in the minimum wage of $1.80--the amount of the federal increase during this period--is expected to reduce coverage by about two percentage points, or nearly half the amount by which coverage fell during this time for full-time workers. Lower-wage environments see larger reductions for a given increase. Also examined is the effect of poor health on work following involuntary job loss. Older workers who lose their jobs are known to experience long absences from full-time work. Since poor health also reduces work, employment after job loss among the sick is of particular interest. Examining panel data from the Health & Retirement Study (HRS), I find that older persons with major health problems return to work at a substantially lower rate than do their healthier counterparts. While poor health is known to reduce labor force participation, little is known about the exact reasons. To explore the possibility that health events may reduce work by impacting mental health, this analysis uses data from the HRS to examine the relationship between onset of illness and reported mental health status among older persons. Reported health events such as cardiovascular disease or stroke have large apparent negative effects on reported mental health measures, though endogeneity concerns should be noted.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Medicare/Medicaid/Health Insurance

Unraveling the SES-Health Connection - James P Smith (Aging, Health and Public Policy: Demographic and Economic Perspectives, 2005)
Keywords: Demographics; Health Conditions and Status

Using a Structural Retirement Model to Simulate the Effect of Changes to the OASDI and Medicare Programs - John Bound; Todd R. Stinebrickner; Timothy A Waidmann (Michigan Retirement Research Center Publication, 2005)
In this paper, we specify a dynamic programming model that addresses the interplay among health, financial resources, and the labor market behavior of men in the later part of their working lives. Unlike previous work which has typically used self reported health of disability status as a proxy for health status, we model health as a latent variable, using self reported disability status as an indicator of this latent construct. Our model is explicitly designed to account for the possibility that the reporting of disability may be endogenous to the labor market behavior we are studying. The model is estimated using data from the Health and Retirement Study. We compare results based on our model to results based on models that treat in the typical way, and find large differences in the estimated effect of health on behavior. While estimates based on our model suggest that health has a large impact on behavior, the estimates suggest a substantially smaller role for health than we find when using standard techniques. We use our model to simulate the impact on behavior of raising the normal retirement age, eliminating early retirement altogether, eliminating the Social Security Disability Insurance program and introducing universal health insurance.
Keywords: Employment and Labor Force; Health Conditions and Status; Methodology

What Explains Differences in Smoking, Drinking and Other Health-Related Behaviors? - David M Cutler; Glaser, Edward (NBER Working Paper, 2005)
We explore economic model of health behaviors. While the standard economic model of health as an investment is generally supported empirically, the ability of this model to explain heterogeneity across individuals is extremely limited. Most prominently, the correlation of different health behaviors across people is virtually zero, suggest that standard factors such as variation in discount rates or the value of life are not the drivers of behavior. We focus instead on two other factors: genetics; and behavioral-specific situational factors. The first factor is empirically important, and we suspect the second is as well.
Keywords: Health Conditions and Status

All in the Family: Providing support to grandchildren and health in midlife - Mary Elizabeth Hughes; Tracey A. LaPierre; Linda J. Waite; Ye Luo (Duke University, 2004)
The purpose of this study was to examine the effects of caring for grandchildren on health behaviors and mental and physical health among older adults. METHODS: Using a sample of 12,872 grandparents aged 50 through 80 from the Health and Retirement Study, we examined the relationship between stability and change in various types of grandchild care and subsequent health, controlling for covariates and earlier health. RESULTS: We found no evidence to suggest that caring for grandchildren has dramatic and widespread negative effects on grandparents' health and health behavior. We found limited evidence that grandmothers caring for grandchildren in skipped-generation households are more likely to experience negative changes in health behavior, depression, and self-rated health. We also found some evidence of benefits to grandmothers who babysit. DISCUSSION: Our findings suggest that the health disadvantages found previously among grandparent caregivers arise from grandparents' prior characteristics, not as a consequence of providing care. Health declines as a consequence of grandchild care appear to be the exception rather than the rule. These findings are important given continuing reliance on grandparents for day care and increasing reliance on grandparents for custodial care. However, the findings should be tempered by the recognition that for a minority of grandparents, coresidential grandchild care may compromise health.
Keywords: Adult children; Demographics; Health Conditions and Status

Are the Impacts of Health Shocks Experienced by the Elderly Cushioned by Socioeconomic Status? - Campbell, Charles; Campbell, Carol (Southwestern Journal of Economics, 2004)
Keywords: Demographics; Health Conditions and Status

Arthritis and Heart Disease as Risk Factors for Major Depression: The role of functional limitation - Dorothy D Dunlop; Lyons, J.S.; Larry M Manheim; Song, Jing; Rowland W Chang (Medical Care, 2004)
Keywords: Health Conditions and Status; Risk Taking

Black-White Mental and Physical Well-Being Following Divorce - Avellar, Sarah A. (University of Michigan, 2004)
Despite the consistent link between divorce and deleterious mental and physical health outcomes, racial variations have been relatively neglected. With divergent socioeconomic statuses, rates of divorce, and other stressors, African-Americans and whites are likely to experience divorce in very different contexts. Racial differences in health outcomes after divorce are often the result of particular constraints and resources, and thus reveal the functioning of social arrangements. I address this issue in three separate but related chapters. In Chapter II, I use five waves of the Health and Retirement Study (HRS) to examine racial differences in divorce outcomes among older people. Today's midlife and elderly cohorts are probably the first to contain a substantial number of divorcees. I model self-rated health, limitations in activities of daily living, other physical limitations, and mortality for 1) the overall sample and 2) a transitioners sample, comprised of respondents who divorce or separate between waves. The results indicate that in the overall sample, divorce affects blacks and whites similarly and negatively, though this is largely accounted for by an individual's wealth. In the transitioners sample, divorce is associated with an improvement in health status, though only for white respondents. In Chapter III, I establish whether the health gap between the divorced and married exists for both blacks and whites. I model self-rated health and depressive symptoms with both waves of the National Survey of Families and Households (NSFH), for a nationally representative sample of all ages. In addition to longitudinal data, I improve on past research by employing multiple estimations of the health gap: ordinary least squares, fixed-effects, and matching models. The results suggest that both blacks and whites experience an increase in depressive symptoms after divorce, but the results for self-rated health are inconsistent and weak. The last analytic chapter, Chapter IV, is an examination of whether other factors can account for the heightened depressive symptoms associated with divorce. Again using the NSFH, I include sociodemographic, psychological, social, and relationship variables in OLS models. For both blacks and whites, the heightened distress can be accounted for by employment, worries about income, and having moved.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Methodology

Crime and Early Retirement Among Older Americans - Daniel S. Silverman; Olivia S. Mitchell (Pension Research Council Working Paper, 2004)
This paper investigates the relationship between local crime rates and the retirement decisions of older Americans. We do so by linking data from the Health and Retirement Study with measures of local crime patterns taken from the Federal Bureau of Investigation s Unified Crime Reports. If we condition on crime rates alone, there is either a weakly positive or no relationship between local crime patterns and older men s propensity to retire early. But unobservable factors associated with early retirement may be correlated with residence in higher-crime rate cities, so next we condition on both the expectation for the crime rate and deviations from average crime levels. We find a positive and statistically significant association between early retirement and expectations for murder rates, and a positive but, on average, imprecisely estimated positive association between early retirement and unexpected increases in crime. The effect of unanticipated increases in crime is greatest, and significant for those in poor health. In this latter group, men are 14 percent more likely to retire early given a standard deviation increase in unexpected murder rates. These findings are consistent with a pattern of more early retirement among those who live in higher crime areas, and earlier retirement among those in poor health when crime levels rise above anticipated levels.
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction

Development and Validation of a Functional Morbidity Index to Predict Mortality in Community-Dwelling Elders - Carey, Elise C.; Louise C Walter; Lindquist, Karla; Kenneth E Covinsky (Journal of General Internal Medicine, 2004)
OBJECTIVE: Functional measures have a great appeal for prognostic instruments because they are associated with mortality, they represent the end-impact of disease on the patient, and information about them can be obtained directly from the patient. However, there are no prognostic indices that have been developed for community-dwelling elders based primarily on functional measures. Our objective in this study was to develop and validate a prognostic index for 2-year mortality in community-dwelling elders, based on self-reported functional status, age, and gender. DESIGN: Population-based cohort study from 1993 to 1995. SETTING: Community-dwelling elders within the United States. PARTICIPANTS: Subjects, age 70 and over (N= 7,393), from the Asset and Health Dynamics Among the Oldest Old study. We developed the index in 4,516 participants (mean age 78, 84 white, 61 female), and validated it in 2,877 different participants (mean age 78, 73 white, 61 female). MAIN OUTCOME MEASURES: Prediction of 2-year mortality using risk factors such as activities of daily living, instrumental activities of daily living, additional measures of physical function, age, and gender. RESULTS: Overall mortality was 10 in the development cohort and 12 in the validation cohort. In the development cohort, 6 independent predictors of mortality were identified and weighted, using logistic regression models, to create a point scale: male gender, 2 points; age (76 to 80, 1 point; 80, 2 points); dependence in bathing, 1 point; dependence in shopping, 2 points; difficulty walking several blocks, 2 points; and difficulty pulling or pushing heavy objects, 1 point. We calculated risk scores for each patient by adding the points of each independent risk factor present. In the development cohort, 2-year mortality was 3 in the lowest risk group (0 to 2 points), 11 in the middle risk group (3 to 6 points), and 34 in the highest risk group ( 7 points). In the validation cohort, 2-year mortality was 5 in the lowest risk group, 12 in the middle risk group, and 36 in the highest risk group. The c-statistics for the point system were 0.76 and 0.74 in the development and validation cohorts, respectively. CONCLUSIONS: This prognostic index, which relies solely on self-reported functional status, age, and gender, provides a simple and accurate method of stratifying communitydwelling elders into groups at varying risk of mortality.
Keywords: Health Conditions and Status; Methodology

Diabetes Diagnosis and Weight Loss in Middle-Aged Adults - Linda A. Wray; Caroline S Blaum; Mary Beth Ofstedal; A. Regula Herzog (Research on Aging, 2004)
Using three waves of Health and Retirement Study data, this study investigated whether (a) self-reported physician-diagnosed diabetes prior to 1994 predicted weight loss between 1994 and 1996 in adults who were aged 51 to 61 and relatively healthy but overweight in 1992 (n = 2,642) and (b) socioeconomic status influenced that relationship. The authors found that these overweight middle-aged adults were at least 50 more likely to report that they lost at least 10 pounds of excess body weight if they had been diagnosed with diabetes than if they had not. Furthermore, the authors found that neither education nor net worth predicted weight loss in these adults. Identifying the social, psychological, and physiological mechanisms linking chronic conditions and health behaviors can inform policy makers and health care providers and enhance the development of effective interventions to prevent or reduce health risks in middle-aged and older adults.
Keywords: Demographics; Health Conditions and Status; Healthcare

On the Distribution and Dynamics of Health Costs - Eric French; John Bailey Jones (Journal of Applied Econometrics, 2004)
Using data from the Health and Retirement Survey and the Assets and Health Dynamics of the Oldest Old survey, we estimate the stochastic process that determines both the distribution and dynamics of health care costs. We find that the data-generating process for log health costs is well represented as the sum of a white noise process and a highly persistent AR(1) process. We also find that the innovations to this process can be modelled with a normal distribution that has been adjusted to capture the risk of catastrophic health care costs. Simulating this model, we find that in any given year 0.1 of households receive a health cost shock with a present value of at least 125,000. Copyright 2004 John Wiley and Sons, Ltd.
Keywords: Health Conditions and Status; Healthcare

Do the Near Elderly Value Mortality Risks Differently from Younger Persons? - Mary F. Evans; Kim, Hyun; Donald H. Taylor Jr. (The Review of Economics and Statistics, 2004)
Wage hedonic models are estimated with the Health and Retirement Study to measure the risk / wage tradeoffs (value of statistical lives) for older workers. The analysis explicitly accounts for multiple employment states including retirement using a multinomial selection model. The results suggest that the oldest and most risk averse workers require significantly higher, not lower, compensation to accept increases in job related fatality risks.
Keywords: Demographics; Expectations; Health Conditions and Status

Documentation of Physical Functioning Measures in the Health and Retirement Study and the Asset and Health Dynamics Among the Oldest Old Study - Stephanie J. Fonda; A. Regula Herzog (The University of Michigan, 2004)
This document is part of a series of working papers on health-related measures in the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest-Old (AHEAD) study. The series currently contains papers on cognitive function, affective function, and physical function, the latter of which is the focus of this document. The purpose of this document is to aid prospective analysts in the appropriate use of the physical functioning data. To do so, this document provides an inventory of the physical functioning measures included in the survey interviews, describes the formats and origins of these measures, discusses their reliability, validity, and change over time and several options for working with the evolution of the questions, and provides SAS code for recoding the variables and creating simple summary measures.
Keywords: Health Conditions and Status; Healthcare; Methodology

Does Childhood Schooling Affect Old Age Cognitive Function? Evidence from Natural Experiments - M. Maria Glymour; Lisa F Berkman; Robins, James M.; Ichiro Kawachi (Harvard University, 2004)
Keywords: Adult children; Demographics; Health Conditions and Status

Effects of Risk and Time Preference and Expected Longevity on Demand for Medical Tests - Gabriel A. Picone; Frank A Sloan; Donald H. Taylor Jr. (Journal of Risk and Uncertainty, 2004)
Despite their conceptual importance, the effects of time preference, expected longevity, uncertainty, and risk aversion on behavior have not been analyzed empirically. We use data from the Health and Retirement Study (HRS) to assess the role of risk and time preference, expected longevity, and education on demand for three measures used for early detection of breast and cervical cancer—regular breast self-exams, mammograms, and Pap smears. We find that individuals with a higher life expectancy and lower time preference are more likely to undergo cancer screening. Less risk averse individuals tend to be more likely to undergo testing.
Keywords: Expectations; Health Conditions and Status; Healthcare

Environmental Influences on Aging in Place - Battisto, Dina G. (University of Michigan, 2004)
Older adults express a strong desire to age in place and this desire increases dramatically with age. Despite their intentions, the disparities between the residential environment and the aging individual are becoming more pronounced with the increase of home-related falls, home modifications, and forced relocations. Two common strategies linked to aging in place are: 1) enhance capabilities of an individual through medical and service interventions such as medications, prostheses, and behavior changes; and 2) reduce environmental constraints and demands. While considerable research targets the first strategy, very few empirical studies show how the environment contributes to aging in place. To understand the environmental influences on aging in place, this research is organized around three general inquiries: 1) explore the factors that are common to people who choose to stay at home as long as possible versus moving, 2) understand the environmental context that is associated with aging in place, and 3) understand an older adult's decision-making process when deciding if and how to age in place. Two environmental perspectives provide a theoretical framework for this study. First, person-environment theories in aging research emphasize "person-environment fit" using interaction models. Second, theories of place in environmental psychology demonstrate the importance of the experiential quality of home for older adults. A "two-phase" research design is used to provide two complementary ways to collect and analyze information on the environmental influences on aging in place. First, correlational research is performed using multiple waves of data previously collected from longitudinal surveys by Asset and Health Dynamics among the Oldest-Old (AHEAD) and the Health and Retirement Study (HRS). Second, face-to-face interviews with older adults 70 years and over living at home allow for a more in-depth understanding of the connections between physical properties of the home, symbolic associations and behaviors. The significance of this study stems from the multi-methodological approach, the focus on the environmental factors contributing to aging in place, and the translation of research findings into a set of empirically-based design recommendations. Findings from this research provide evidence that an environmental approach is a prerequisite to aging in place.
Keywords: Health Conditions and Status; Healthcare; Housing; Public Policy

Financial Status of Older Americans Aged 70 and Above: A comparison of successive age cohorts - Lee, Yoon G. (Hallym International Journal of Aging, 2004)
Using data from the 1994 Survey of Asset and Health Dynamics among the Oldest Old (AHEAD), this study examines the economic status of older individuals aged 70 or older, while comparing income sources and financial portfolios across four age cohorts (70-74, 75-79, 80-84, and 85 or older). Ordinary least squares (OLS) regression analyses with dummy variables for age were used to identify the effects of different age cohorts on the level of financial assets, home equity, and net worth. Older individuals aged 85 and older had significantly lower net worth than did those aged 70-74 older. This study further investigates the factors influencing the level of net worth for each of the four age groups. Implications and conclusions are drawn based on the findings of the study.
Keywords: Demographics; Health Conditions and Status; Net Worth and Assets

Health and Family Labor Force Transitions - Mark C. Berger; Messer-Pelkowski, Jodi (Quarterly Journal of Business and Economics, 2004)
We examine the labor force participation responses of older families to changes in the health of family members in the U.S. using the Health and Retirement Study. We estimate transitions among four labor force states for married couples: both working, husband working, wife working and neither working. We find evidence that the onset of health problems increase the probability that the affected individual leaves the labor market. The unaffected spouse is likely to continue working if originally working, but is not likely to enter the labor market if not originally working following the onset of health problems of the spouse. Comparing our results to previous studies suggests that family responses to health changes have remained fairly stable over time in the U.S. In contrast, differences exist in family responses to health changes in the U.S. and Germany, possibly reflecting differences in the institutional environments in the two countries.
Keywords: Consumption and Savings; Disabilities; Employment and Labor Force; Health Conditions and Status; Time Use

Health and Wealth of Elderly Couples - Pierre-Carl Michaud; Arthur H.O. vanSoest (RAND Labor and Population Series, 2004)
Keywords: Adult children; Demographics; Health Conditions and Status; Net Worth and Assets

The Health Effects of Retirement: A Theoretical and Empirical Investigation - Neuman, Kevin (University of Notre Dame, 2004)
This study strives to answer the question of how retirement affects health. Assessing how retirement affects health leads to better estimates of health care costs and a better understanding of the retirement decision. The study develops a model of health investment where individuals maximize lifetime utility derived from consumption goods, leisure and healthy time and produce health using leisure and medical goods. Solving the model generates an equilibrium condition for health investment. Assuming that healthy time is a normal good, the model predicts that retirement will increase health investment and thus health for retirees in the next period relative to workers. The empirical test uses a sample of older adults from the longitudinal Health and Retirement Study. To account for the endogeneity of the retirement decision the study employs an instrumental variable model exploiting exogenous variation in Social Security and private pension benefits. The study also improves on previous work by estimating a model where health change in one period is regressed on previous period retirement status allowing the health stock time to adjust to changes in investment behavior. Using subjective health measures, the study finds that retirement decreases the probability of a good health change for men by over 8%, but increases the probability for women by 15%. The difference between sexes persists using a sample of women who worked a significant number of years in their lifetime, and is not due to the particular set of instruments used. Retirement also preserves health for both sexes, reducing the probability of a health decline by 2.5% for men and 3.5% for women. Comparing the subjective results to objective measures reduces concerns about reporting bias for the negative effects for men although the results cannot rule out role bias in the positive results for women. The results recommend leaving the Social Security early entitlement age untouched, or extending Medicare and disability coverage to those in poor health who are forced to work by entitlement age increases, potentially allowing individuals to enter retirement in better health, reducing health care costs.
Keywords: Consumption and Savings; Disabilities; Health Conditions and Status; Public Policy; Retirement Planning and Satisfaction; Social Security

Identifying Social Determinants of Old Age Cognitive Function - M. Maria Glymour (Harvard University, 2004)
Keywords: Demographics; Health Conditions and Status

The Impact of Health on Employment, Wages and Hours Worked Over the Life Cycle - Pelkowski, J.M.; Mark C. Berger (Quarterly Review of Economics and Finance, 2004)
This paper examines the effect of health problems on employment, annual hours worked and hourly wages. The Health and Retirement Study data are used to compile employment and health experience profiles over the lifetimes of respondents. These profiles are used to estimate the impact of temporary and permanent illnesses. Permanent health conditions have negative effects on labor market outcomes. Females are found to have larger reductions in wages, but males have bigger decreases in hours worked. The onset of health problems in the 40s produces the largest negative consequences for males, while for females negative effects peak in the 30s. 2003 Board of Trustees of the University of Illinois. All rights reserved.
Keywords: Employment and Labor Force; Health Conditions and Status

A Longitudinal Look at the Predictors of Four Types of Retirement - Weymouth, Penny L. (Central Michigan University, 2004)
The general purpose of the study was to further the understanding of the retirement process. More specifically, the study investigated several personal and work-related predictors of individual retirement status that have received relatively little past examination. By gaining a better understanding of the retirement process, policy makers and organizational leaders can use this knowledge to make informed decisions affecting older workers, their organizations, and society in general. Public release data of the Health and Retirement Study (HRS)--a recent, large, representative, national panel study that focuses on the health, retirement, and aging of persons born between the years of 1931 and 1941--were analyzed. In-home, face-to-face interviews were conducted in 1992, with follow-up interviews conducted every two years by phone. From survey years 1992 through 2000, samples of working individuals over the age of 50 were used to examine nine hypotheses and four different operationalizations of retirement. The hypotheses involved the following predictor variables: gender, partner status, characteristics of one's partner (i.e., retirement status and health), number of dependents, obsolescence of job skills, "demanding" job characteristics, perceived age-related discrimination, work and retirement attitudes, and flexibility of organizational policies regarding older workers. Event history analysis using logistic regression was used to predict the dichotomous criterion variables, while linear mixed model analysis for repeated measures was used to predict the continuous dependent variable. After statistically controlling variables such as age, health, and finances, results indicated that gender, partner's retirement status, work and retirement attitudes, and organizational flexibility were each predictors of at least one type of retirement. In addition, the statistical interaction of gender with partner status predicted retirement defined in several ways. The study expanded what is known about retirement predictors by examining actual versus intended retirement behavior and increased the generalizability of past research by utilizing national panel data. The study also highlighted the importance of clearly defining retirement measures and explored the complete versus partial retirement typology. It was suggested that flexible work options may improve work and retirement attitudes by making the transition into retirement a gradual process, and may keep older employees in the work force longer.
Keywords: Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction

Predicting Nursing Home Admission: Estimates from a seven-year follow-up of a nationally representative sample of older Americans - Banaszak-Holl, Jane; A. Mark Fendrick; Norman L Foster; A. Regula Herzog; Mohammed U Kabeto; Kent, David; Walter L. Straus; Kenneth M. Langa (Alzheimer Disease and Associated Disorders, 2004)
This study determines whether prevalence and predictors of nursing home admission changed in the 1990s, during a period of dramatic changes in the service provision for and medical care of chronic impairments. Data from the 1993-2000 surveys of the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, a longitudinal and nationally representative sample, were used. Proportional hazard models were used to determine the effects of dementia, physical functioning, clinical conditions, and sociodemographics on the likelihood of nursing home admission. Of the 6,676 respondents, 17 were admitted to a nursing home. Models excluding functional impairment demonstrated significant effects of chronic medical conditions and dementia on the risk of institutionalization. After controlling for functional impairment, dementia still had significant and strong effects on institutionalization but clinical conditions did not, suggesting that the impact of dementia goes beyond its effect on physical functioning. Nursing home admissions did not decrease during the study period, and the impact of dementia on the risk of nursing home admission did not decrease. Interventions for individuals with dementia should impact the behavioral aspects of the condition and slow disease progression in addition to improving physical functioning.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology

The Price of Smoking - Frank A Sloan; Ostermann, Jan; Gabriel A. Picone; Conover, Christopher; Donald H. Taylor Jr. (MIT Press, 2004)
Keywords: Consumption and Savings; Health Conditions and Status

Race/Ethnicity, Socioeconomic Status, and Health - Eileen M. Crimmins; Mark D Hayward; Teresa Seeman (Critical Perspectives on Race and Ethnic Differences in Health in Later Life, 2004)
Mounting evidence indicates that racial/ethnic differences in morbidity and mortality are tied to socioeconomic resources (Hayward, Crimmins, Miles, and Yu, 2000; Williams and Collins, 1995). Largely because of data availability, most of this evidence is based on the health experiences of blacks and whites, with much less evidence on the role of socioeconomic factors in understanding racial/ethnic disparities when Americans of Asian or Pacific Island descent, Hispanics, and Native Americans are part of the picture. The potential power of the socioeconomic status (SES) paradigm in understanding health disparities—including racial/ethnic disparities—is evident in the fact that socioeconomic differences in health outcomes have been widely documented for most health conditions in most countries. People who are poorer and who have less education are more likely to suffer from diseases, to experience loss of functioning, to be cognitively and physically impaired, and to experience higher mortality rates (Adler, Boyce, Chesney, Folkman, and Syme, 1993; Adler et al., 1994; Marmot, Kogevinas, and Elston, 1987; Marmot, Ryff, Bumpass, Shipley, and Marks, 1997; Preston and Taubman, 1994; Williams, 1990). In the United States, few health problems are more likely to occur among those who are better off, and some health conditions are particularly sensitive to SES. In recent years socioeconomic differences in health also appear to be increasing in the United States and in other developed countries (Crimmins and Saito, 2001; Feldman, Makuc, Kleinman, and Coroni-Huntley, 1989; Manton, 1997; Marmot, 1994; Pappas, Queen, Hadden, and Fisher, 1993; Preston and Elo, 1995).
Keywords: Demographics; Health Conditions and Status; Healthcare; Women and Minorities

Reduction of quantity smoked predicts future cessation among older smokers - Tracy Falba; Jofre-Bonet, Mireia; Susan H. Busch; Duchovny, Noelia; Jody L Sindelar (Addiction, 2004)
AIM: To examine whether smokers who reduce their quantity of cigarettes smoked between two periods are more or less likely to quit subsequently. STUDY DESIGN: Data come from the Health and Retirement Study, a nationally representative survey of older Americans aged 51-61 in 1991 followed every 2 years from 1992 to 1998. The 2064 participants smoking at baseline and the first follow-up comprise the main sample. MEASUREMENTS: Smoking cessation by 1996 is examined as the primary outcome. A secondary outcome is relapse by 1998. Spontaneous changes in smoking quantity between the first two waves make up the key predictor variables. Control variables include gender, age, education, race, marital status, alcohol use, psychiatric problems, acute or chronic health problems and smoking quantity. FINDINGS: Large (over 50 ) and even moderate (25-50 ) reductions in quantity smoked between 1992 and 1994 predict prospectively increased likelihood of cessation in 1996 compared to no change in quantity (OR 2.96, P 0.001 and OR 1.61, P 0.01, respectively). Additionally, those who reduced and then quit were somewhat less likely to relapse by 1998 than those who did not reduce in the 2 years prior to quitting. CONCLUSIONS: Reducing successfully the quantity of cigarettes smoked appears to have a beneficial effect on future cessation likelihood, even after controlling for initial smoking level and other variables known to impact smoking cessation. These results indicate that the harm reduction strategy of reduced smoking warrants further study.
Keywords: Health Conditions and Status

Relationship of Body Mass and Net Worth for Retirement-Aged Men and Women - Stephanie J. Fonda; Fultz, Nancy H.; Kristi Rahrig Jenkins; Wheeler, Laura M.; Linda A. Wray (Research on Aging, 2004)
This article examines linkages between body weight and socioeconomic status (SES) among Americans at or near retirement age. The authors hypothesize that (a) body weight relates negatively to SES, (b) this relationship is greater for women than men, and (c) the relationship attenuates when health, employment, and marital status are controlled.We use the 1992 Health and Retirement Study for this examination. SES is measured as net worth. Body weight is measured as body mass index and categorized as normal weight, overweight, and obese. Results indicate that, for women, overweight and obesity relate to lower logged networth. This relationship attenuates once covariates are considered. For men, overweight and obesity relate to higher logged net worth, even when covariates are considered. The findings suggest that greater weight has different meanings for men and women in this cohort; it might be related to success for men but a sociocultural detriment for women.
Keywords: Health Conditions and Status; Net Worth and Assets

Religion and the Use of Female Preventive Services - Benjamins, Maureen Reindl (University of Texas at Austin, 2004)
Keywords: Demographics; Health Conditions and Status

Is Retirement Depressing? Labor Force Inactivity and Psychological Well-Being in Later Life - Kerwin K. Charles (Accounting for Worker Well-Being, 2004)
Keywords: Employment and Labor Force; Health Conditions and Status; Other

Retirement Transitions: The role of shocks to household resources - Kim, Sora (The Ohio State University, 2004)
The role of shocks to household resources in affecting retirement transitions among older employees was analyzed using data from the Health and Retirement Study (HRS). The transitions of reverse retirement and partial retirement were of particular interest. The objectives of the study were: 1) To explore how shocks, or unexpected changes to financial and human resources, affect retirement transitions, and 2) To explore the relative importance of shocks in making retirement transitions. The study sample consisted of 2,514 HRS respondents, born between 1926 and 1938, who changed employment status between 1998 and 2000 or between 2000 and 2002. A multinomial Logit model was used in order to make comparisons among the four retirement transition groups. The empirical model included institutional variables and demographic and environmental control variables. The results suggest that just as the paths to retirement are diverse and complex, so are their determinants. Shocks to financial resources had the largest effects on reverse retirement transitions. Shocks to human resources, including family structure and health, affected all retirement transitions. Institutional variables had the largest marginal effects on partial retirement. As expected, positive shocks to assets decreased the odds of reverse retirement, and negative income shocks had larger marginal effects on retirement transitions than positive income shocks. However, positive asset shocks had larger marginal effects on retirement transitions than negative asset shocks. The partial retirement group was distinguished from the reverse retirement group in terms of financial shock impacts; for members of the partial retirement group, rather than shocks to resources, institutional supports were key determinants. Fewer significant effects on the odds of partial retirement over traditional retirement were found, and the effects were smaller than those for reverse retirement and retirement from part-time employment in terms of their magnitudes. The loss of human resources was important across the transition groups, with greater impact of shock to marital status on women's labor force transitions compared to men's. To reduce shocks to household resources under uncertainty, retirement education should encompass information on asset allocation and financial risk. These topics may help workers more effectively plan for retirement.
Keywords: Health Conditions and Status; Healthcare; Methodology; Net Worth and Assets; Retirement Planning and Satisfaction

Review of: The smoking puzzle: Information, risk perception, and choice - Jahn K. Hakes (Journal of Economic Literature, 2004)
Keywords: Consumption and Savings; Health Conditions and Status; Healthcare; Methodology; Public Policy

Selection Correction and Sensitivity Analysis for Ordered Treatment Effect on Count Response - Lee, Myoung Jae (Journal of Applied Econometrics, 2004)
In estimating the effect of an ordered treatment on a count response y with an observational data where tau is self selected (not randomized), observed variables x and unobserved variables epsilon can be unbalanced across the control group (tau = 0) and the treatment groups (tau = 1, . . . , J). While the imbalance in x causes overt bias which can be removed by controlling for x, the imbalance in epsilon causes covert (hidden or selection) bias which cannot be easily removed. This paper makes three contributions. First, a proper counter factual causal framework for ordered treatment effect on count response is set up. Second, with no plausible instrument available for tau, a selection correction approach is proposed for the hidden bias. Third, a nonparametric sensitivity analysis is proposed where the treatment effect is nonparametrically estimated under no hidden bias first, and then a sensitivity analysis is conducted to see how sensitive the nonparametric estimate is to the assumption of no hidden bias. The analytic framework is applied to data from the Health and Retirement Study: the treatment is ordered exercise levels in five categories and the response is doctor office visits per year. The selection correction approach yields very large effects, which are however ruled out by the nonparametric sensitivity analysis. This finding suggests a good deal of caution in using selection correction approaches.
Keywords: Health Conditions and Status; Methodology

Social, Cultural, and Economic Capital, and Behavioral Investments in Health - Patrick M. Krueger (University of Colorado at Boulder, 2004)
I develop a health stratification perspective to examine whether differential access to social, cultural, and economic capital account for differences in individuals' abilities and proclivities to behaviorally invest in their health. I suggest that each form of capital derives from key social institutions. To test my theoretical framework, I use the 1998 and 2000 waves of the Health and Retirement Study (HRS) to examine changes in health behaviors over a two year period. The HRS provides a nationally representative sample of adults aged 51 and older and has detail on six key behaviors, including physical activity, smoking, binge drinking, preventive blood cholesterol tests, preventive cancer screening behaviors, and flu shot receipt. First, Chapter 4 examines the relationship between socioeconomic status (SES) and behavioral investments in health. I find that socioeconomic position is multidimensional and indicates people's locations in diverse institutions including the occupational hierarchy, education, employment, and the financial marketplace. Although much prior work assumes that diverse socioeconomic measures are indicators of a single underlying concept, I find that each dimension of SES has a unique association with various health behaviors. Second, Chapter 5 examines the relationship between employment, gender, and marital status. Prior research suggests that employment enhances the health of both men and women. Further, wives often have better health if their husbands work, but husbands typically have worse health if their wives work. I fail to find support for this relationship when examining health behaviors; thus prior theoretical work may not adequately explain various dimensions of health. Finally, Chapter 6 finds that marriage generally promotes healthier lifestyles among men and women. However, the quality of the marriage is important--those whose spouses have healthier lifestyles undertake healthier behaviors than those whose spouses have less healthy lifestyles. Further, prior work suggests that marriage benefits the health of men more than women. But I find that marriage benefits women more than men for some health behaviors. Thus, health research may be inadequate if it focuses on a limited number of health indicators.
Keywords: Adult children; Demographics; Health Conditions and Status; Methodology

Social Interaction and Stock Market Participation - Hong, Harrison; Kubik, Jeffrey D.; Stein, Jeremy C. (Journal of Finance, 2004)
We propose that stock-market participation is influenced by social interaction. In our model, any given social investor finds the market more attractive when more of his peers participate. We test this theory using data from the Health and Retirement Study, and find that social households those who interact with their neighbors, or attend church are substantially more likely to invest in the market than non-social households, controlling for wealth, race, education, and risk tolerance. Moreover, consistent with a peer-effects story, the impact of sociability is stronger in states where stock-market participation rates are higher.
Keywords: Health Conditions and Status; Net Worth and Assets

Transitions of Functional Disabilities in the United States Elderly with Diabetes Mellitus - Chanprasert, Puongpen (University of Massachusetts, Boston, 2004)
Based on the Disablement Process Framework developed by Verbrugge and Jette (1994), this study entailed an empirical examination of the association between functional status changes among U.S. elders with diabetes and the risk factors, including sociodemographic, health, lifestyle, and extra-individual factors. The main data source was the Assets and Health Dynamics Among the Oldest Old Wave 1 (1993) and Wave 2 (1995). The study samples included 7,443 elders aged 70 years and over, of which 993 were diabetic and 6,450 were non-diabetic. Descriptive statistics and multinomial logit regression analyses were used to examine the associations between functional status changes and risk factors among the whole sample of elders, and among elders with and without diabetes. The descriptive statistics reveal significant differences in the prevalence of impairments in activities of daily living (ADLs) and of mobility functions at Wave 1 between diabetic and non-diabetic elders, and between diabetic women and men. In each case, the former had a higher prevalence than the latter. The empirical findings suggest that diabetic elders who used either medication or insulin injections had higher odds of experiencing ADL and mobility function declines compared to non-diabetic elders. Factors affected functional status declines for both diabetic and non-diabetic elders were age, chronic pain, baseline mobility function difficulties, stroke, cancer, and arthritis. In addition, taking medication, insulin injection (both reflecting aspects of disease severity), as well as higher income, low BMI, and Medicaid, were found to be positively associated with functional status decline among diabetics. Finally, college education, separated or divorced, heart condition, and primary insurance, were found to be negatively associated with functional status decline among diabetics. The empirical findings have implications that are related to the individual management of diabetes, group disease management programs, promotion of education for current and potential diabetics, smoking cessation support, and the importance of health insurance. Each of these areas should be targeted by policy changes to delay the onset of disease and its resulting disabilities for diabetic elders, healthy adults, and elders in the general population. The current study's approach should be replicated in a larger sample of diabetic elders.
Keywords: Disabilities; Health Conditions and Status; Risk Taking

TREAT 'EM: Triangulation, Risk, and the Economics of Alcoholism and Treatment among Elders in Medicare - Pringle, Kristine Elmendorf (College of Health and Human Development, 2004)
This dissertation is divided into three distinct, but related studies on alcoholism among elderly persons. The purpose of the first study was to triangulate between two large, secondary data sources to determine the risk factors for both diagnosed and self-reported alcoholism. Claims data from the Medicare Current Beneficiary Survey were used to examine individuals with diagnosed alcoholism and survey responses to the CAGE questions in the Health and Retirement Study were used to examine individuals with self-reported alcoholism. The results of study one suggest that less than half of individuals who self-report would be diagnosed (4.31% versus 1.87%, respectively), and some groups may be at particularly high risk of under-diagnosis. The purpose of the second study was to examine factors associated with alcohol treatment among a sample of 390 elderly Medicare beneficiaries already diagnosed with alcoholism and to produce cost estimates for alcohol treatment. A generalized linear model with a gamma distribution and log link was used to estimate treatment costs in the 12 months following diagnosis. The results of study two suggest that about half (52.6%) of elderly individuals diagnosed with alcoholism receive any treatment for alcoholism, and certain groups of diagnosed elderly may be at high risk of under-treatment. The cost of alcohol treatment for individuals diagnosed with alcoholism is $9,714.16 per year. The purpose of the third study was to test the cost-offset hypothesis, (a phenomenon where treatment for alcohol problems reduces the use of medical services), using five years of claims data from the Medicare Current Beneficiary Survey. Two distinct methodological approaches, propensity scoring and difference-in-differences, were used to estimate treatment effects. Although insufficient power likely limited my ability to detect significant differences, the results of this study are encouraging and warrant further study of larger samples over longer periods of time. Taken together, the results of this research particularly highlight the need for targeted interventions to increase detection of those not yet diagnosed and treatment seeking among those already diagnosed with alcoholism. Such interventions may reduce the need for subsequent medical hospitalizations caused by the complications of alcoholism, especially among those with acute onset.
Keywords: Health Conditions and Status; Healthcare; Public Policy

The Well-Being of Retirees: Evidence Using Subjective Data - Bender, Keith A. (Center for Retirement Research at Boston College Working Papers, 2004)
While previous economic research focuses on the financial well-being of retirees, this paper examines the determinants of overall well-being of retirees. Using data from the 2000 Health and Retirement Study, the strongest predictor of retirement well-being is the reason for entering retirement. If individuals were forced to retire, their well-being is significantly lower than those who chose to retire. This indicates the importance of expectations on retirement satisfaction. Additionally, health, current income, and comparison retirement income have important roles in determining overall well-being.
Keywords: Expectations; Health Conditions and Status

Aging Subsidized Housing Residents: A Growing Problem in U.S. Cities - Gibler, Karen M. (Journal of Real Estate Research, 2003)
Many low-income elderly live in subsidized housing in central cities. These aging tenants need aadaptive physical structures and supportive services in order to age in place, but lack the resources to pay for them. The responses to the AHEAD Wave 2 survey are used to compare the housing conditions of elderly subsidized housing residents with unsubsidized tenants. Results indicate subsidized tenants have greater health and physical limitations. They are likely to have physically appropriate housing, but unlikely to have access to supportive services that would allow them to age in place, creating a problem that policymakers must address.
Keywords: Health Conditions and Status; Housing

Assistance to Aging Parents and Parents-in-Law: Does lineage affect family allocation decisions? - Kim Shuey; Melissa A. Hardy (Journal of Marriage and the Family, 2003)
In this analysis we used data from the Health and Retirement Study to examine how, couples organize transfers of assistance to aging parents and whether the flow of assistance is structured by family lineage. We found evidence of a tradeoff between types of assistance and a unilineal pattern of assistance. Few couples provided both time and money, and few assisted parents and parents-in-law. The determinants of assistance varied by type of care, recipient, and patterns of parental survival. Couples were more responsive to the needs of the wife's parent(s) and were less likely to exclude her parents from care even tinder circumstances of competition. Controlling for resources, African American and Hispanic couples were consistently more likely to provide assistance.
Keywords: Adult children; Health Conditions and Status; Healthcare

Commentary on "Trends in Scores on Tests of Cognitive Ability in the Elderly U.S. Population, 1993-2000" : Beyond inconsistent results: finding the truth about trends in late-life cognitive funtioning - Vicki A Freedman; Linda G Martin (The Journals of Gerontology: Social Sciences, 2003)
Two years ago, Freedman, Aykan, and Martin (2001) reported that the percentage of older Americans with severe cognitive impairment had declined significantly from 6.1% in 1993 to 3.6% in 1998. These apparent improvements were not explained by changes in demographic and socioeconomic composition or the prevalence of stroke, vision, or hearing impairments. We concluded cautiously that older persons appeared to have better cognitive functioning at the end of the decade. In a companion piece (Freedman, Aykan, and Martin, 2002), we showed that these results were robust to a variety of assumptions about missing data, loss to follow-up, and the institutional population, and called for replication with future waves of the Health and Retirement Study (HRS).
Keywords: Demographics; Health Conditions and Status

The Costs of Arthritis - Dorothy D Dunlop; Larry M Manheim; Yelin, Edward; Song, Jing; Rowland W Chang (Arthritis and Rheumatism, 2003)
Arthritis and rheumatic conditions (i.e., arthritis) are responsible for major health care expenditures and disability burdens. The impact of arthritis is not restrained by national boundaries. It is one of the most prevalent chronic conditions and is a leading cause of disability in Australia (1), Canada (2,3), Europe (4), the United Kingdom (5), and the United States (6,7), affecting an estimated 3 million Australians, 6 million Canadians, 8 million in the UK, almost 43 million people in the US, and 103 million across Europe. With the aging of the baby boomers, these numbers and the associated disabilities will quickly escalate. By 2020 in the US alone, arthritis is projected to affect 60 million people, and the activities of 12 million people may be limited by arthritis (6). The growing magnitude of people affected by arthritis motivates the need to review what is known about its national costs to identify areas where current information is lacking. In addition, it is important to determine targets for public health efforts that will reduce the costs of and burden from arthritis. This knowledge will facilitate planning research agendas that support informed public policy decisions.
Keywords: Health Conditions and Status; Healthcare

Disability and Employment: Reevaluating the Evidence in Light of Reporting Errors - Kreider, Brent; John V Pepper (Center for Retirement Research, 2003)
Long-standing debates about relationships between labor supply behavior and health status among persons nearing retirement age have centered largely on disagreements about the reliability of self-reported health indicators. In light of reporting errors in work capacity, this paper considers the problem of predicting how employment rates vary with disability status when true disability is unobserved. Rather than imposing the strong assumptions required to obtain point identification, we take a step back to evaluate what can be inferred under a variety of assumptions that are weaker but arguably more credible than those imposed in the existing literature. Although these assumptions do not identify the conditional employment rates except in special cases, nonparametric bounds for these parameters can be obtained. Using data from the Health and Retirement Study, we estimate a set of bounds that formalize the identifying power of a number of different assumptions that appear to have broad consensus in the literature. Our results suggest that models estimated under the assumption of fully accurate reporting lead to biased inferences. In particular, it appears that nonworkers tend to overreport disabilities.
Keywords: Employment and Labor Force; Health Conditions and Status; Methodology

Does the Current Climate Discourage Seasoned Pros? - Greene, Kelly (Wall Street Journal, 2003)
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction

The Effect of Health on Retirement Saving Among Older Workers - Lum, Y.S.; Lightfoot, Elizabeth (Social Work Research, 2003)
Using data from the first wave of the Health and Retirement Study, the authors investigated the association between health and retirement saving. The two most important findings were that (1) health has a large, significant effect on both the probability that a person nearing retirement age will contribute to an IRA and the amount of money that a person Will hold in IRAs, and (2) a spouse's health has a large, significant effect on a person's access to an employer-sponsored pension, the probability that a person will contribute to an IRA, and the amount of money held in an IRA.
Keywords: Consumption and Savings; Health Conditions and Status; Pensions; Social Security

Effects of Demographic and Health Variables on Rasch Scaled Cognitive Scores - Elizabeth Zelinski; Gilewski, M.J. (Journal of Aging and Health, 2003)
Objectives: To determine whether demographic and health variables interact to predict cognitive scores in Asset and Health Dynamics of the Oldest-Old (AHEAD), a representative survey of older Americans, as a test of the developmental discontinuity hypothesis. Methods: Rasch modeling procedures were used to rescale cognitive measures into interval scores, equating scales across measures, making it possible to compare predictor effects directly. Rasch scaling also reduces the likelihood of obtaining spurious interactions. Tasks included combined immediate and delayed recall, the Telephone Interview for Cognitive Status (TICS), Series 7, and an overall cognitive score. Results: Demographic variables most strongly predicted performance on all scores, with health variables having smaller effects. Age interacted with both demographic and health variables, but patterns of effects varied. Discussion: Demographic variables have strong effects on cognition. The developmental discontinuity hypothesis that health variables have stronger effects than demographic ones on cognition in older adults was not supported.
Keywords: Health Conditions and Status

The Effects of Health Events on the Economic Status of Married Couples - Stephen Wu (The Journal of Human Resources, 2003)
This paper uses measures of exogenous health shocks to identify the different channels through which changes in health conditions affect income, wealth, and consumption behavior. The results indicate that serious health conditions have strong effects on household wealth, but that the effects for women are larger and more significant than the effects for men. The source of the asymmetry arises from the fact that general living expenses increase when wives become seriously ill, while for husbands, health shocks do not affect these expenditures.
Keywords: Adult children; Employment and Labor Force; Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction

Fall Risk Factors in Older Americans (Texas Tech University, 2003)
Older American consumers require accurate and complete information to make informed decisions regarding health. Falls are a significant problem in older Americans and are negatively associated with quality of life and health. Current fall risk models are costly, expensive, and do not represent all reasons for falls. The purpose of this study was to investigate demographic and psychological well being variables to determine if they could improve the information provided from current fall risk models. This information could be used preventatively to reduce fall risk in older Americans. The study was a cross sectional, longitudinal survey design using the Health and Retirement Study (HRS) database. The sample consists of over 11,000 Americans 65 and older and is generalizable to the older population within the United States. An association between the demographic risk factors (age, marital status, gender education, and monthly expenditure) as well as psychological well being risk factors (positive attitude, loneliness, anxiety, activity level, depression, and perceived health) was compared with the variables fall incidence, fall with injury and fall frequency in a population of Americans 65 and older. The sample was limited to those who were home dwelling in the contiguous 48 states. Several variables were significant in their association with fall incidence, fall with injury and fall frequency. The variables age, depression and anxiety were positively associated with fall incidence, fall with injury and fall frequency. The variables Black, and report of good perceived health were associated negatively with fall incidence, fall with injury and fall frequency. Other variables had mixed associations. Being male was negatively associated with fall incidence, and fall with injury but positively associated with fall frequency. Positive attitude was positively associated with falls but negatively associated with fall frequency. Being Hispanic was negatively associated and increased monthly expenditure was positively associated with fall frequency. The results of this study could improve current fall risk models and may assist in providing preventative intervention for "at-risk" older Americans.
Keywords: Demographics; Health Conditions and Status

Health Shocks and Couples' Labor Supply Decisions - Courtney Coile (Center for Retirement Research at Boston College, WP 2003-08, 2003)
This paper explores the effect of negative health shocks, such as heart attacks or new diagnoses of chronic illnesses, on the labor supply of both the affected spouse and his or her partner. In so doing, the paper links two important strands of the retirement literature, the large literature on health and retirement and the small but growing literature modeling retirement in a family context. This paper may also be viewed as an extension of the literature on spousal labor supply as insurance against negative events, which measures whether there is an added worker effect when one spouse becomes sick and whether it is crowded out by public insurance programs. This work uses the first five waves of the Health and Retirement Study (HRS), a recent, nationally representative survey of the young elderly with extensive information on health, labor force status, and demographics.
Keywords: Adult children; Employment and Labor Force; Health Conditions and Status

Health, Wealth, and the Role of Institutions - Michael D Hurd; Arie Kapteyn (Journal of Human Resources, 2003)
A positive relationship between socioeconomic status and health has been observed over many populations and many time periods. One of the factors mediating this relation is the institutional environment in which people function. We consider longitudinal data from two countries with very different institutional environments. the United States and The Netherlands. To structure the empirical analysis. we develop a theoretical model relating changes in health status to income and changes in income to health status. We show that income or wealth inequality is closely connected with health inequality. We empirically estimate counterparts to the theoretical relationships with generally corroborative results.
Keywords: Demographics; Health Conditions and Status

Healthy, wealthy, and wise? Tests for direct casual paths between health and socioeconomic status - Adams, Peter; Michael D Hurd; Daniel McFadden; Merrill, Angela; Ribeiro, Tiago (Journal of Econometrics, 2003)
This paper provides statistical methods that permit the association of socioeconomic status and health to be partially unraveled in panel data by excluding some postulated causal paths, or delimiting their range of action. These methods are applied to the Asset and Health Dynamics of the Oldest Old (AHEAD) Panel to test for the absence of causal links from socioeconomic status (SES) to health innovations and mortality, and from health conditions to innovations in wealth. We conclude that in this elderly American population, where Medicare covers most acute care and pension income is not affected by ability to work, the evidence supports the hypothesis of no direct causal link from SES to mortality and to incidence of most sudden onset health conditions (accidents and some acute conditions), once initial health conditions are controlled, but there is an association of SES with incidence of gradual onset health conditions (mental conditions, and some degenerative and chronic conditions), due either to causal links or to persistent unobserved behavioral or genetic factors that have a common influence on both SES and innovations in health. There is little evidence to support a broad association of health conditions and wealth changes. The death of a spouse appears to have a negative effect on the wealth of the survivor; this is plausibly a direct causal effect. There is evidence for some association of health conditions with increased dissaving from liquid wealth for intact couples and singles. From these findings, we conclude that there is no evidence that SES-linked therapies for acute diseases induce mortality differentials. The question of whether SES linked preventative care influences onset of chronic and mental diseases remains open.
Keywords: Demographics; Health Conditions and Status; Socioeconomic factors

How Do Negative Events Shape the Subsequent Work-Family Life Course? The case of involuntary versus voluntary retirement - Dentinger, Emma (Cornell University, 2003)
This dissertation examines whether it matters that someone retires voluntarily or involuntarily. Specifically, I investigate three possibilities for life after retirement: subsequent reemployment, divorce, ad major health problems (heart attacks and death). The question I address is: does knowing whether or not one retires voluntarily or involuntarily (due to health problems or downsizing, for example) aid in predicting any of those outcomes after retirement? Do these processes operate differently for various subgroups, such as by race and gender? To do this, I employ Cox event history techniques using the University of Michigan's 1992 - 1998 Health and Retirement Study (HRS). I find that men and women in their 50s, 60s and 70s who are forced to retire for job-related reasons between 1992 and 1998 are more likely to engage in post-retirement employment compared to those who voluntarily retire, adapting to this unexpected transition by re-engaging in the work role. In contrast, men and women who retire for health reasons during this time are less likely to engage in post-retirement employment (for women this is dependent on having a pension) and more likely to experience cumulative health disadvantage. However, men who retire involuntarily for health-related reasons (for their own health or a family member's) are also less likely to divorce post-retirement than are men who are voluntary retirees. Spousal influences, measured by marital status in the combined models and spousal characteristics among the married sample, appear to be significant factors in various ways. For example, women who are divorced, separated or widowed prior to retirement are more likely to re-engage in the work role, reflecting their generally weaker economic positions. Married and partnered men are more likely than single men to re-engage in paid work. I find no confirmation for the prediction that women's family circumstances, such as having a child living at home, are more consequential for their post-retirement experiences than men's family circumstances on their own experiences. Life post-retirement for both men, and women is affected by family influences about equally, albeit in different ways.
Keywords: Adult children; Health Conditions and Status; Retirement Planning and Satisfaction

The Marginal Propensity to Spend on Adult Children - Joseph G Altonji; Villanueva, Ernesto (NBER Working Paper, 2003)
We examine how much of an extra dollar of parental lifetime resources will ultimately be passed on to adult children in the form of inter vivos transfers and bequests. We infer bequests from the stock of wealth late in life. We use mortality rates and age specific estimates of the response of transfers and wealth to permanent income to compute the expected present discounted values of these responses to permanent income. Our estimates imply that parents pass on between 2 and 3 cents out of an extra dollar of expected lifetime resources in bequests and about 2 cents in transfers. The estimates increase with parental income and are smaller for nonwhites. They imply that about 15 percent of the effect of parental income on lifetime resources of adult children is through transfers and bequests and about 85 percent is through the intergenerational correlation in earnings, although these estimates are sensitive to assumptions about the intergenerational earnings correlation, taxes, and the number of children. We compare our estimates to the implications of alternative computable benchmark models of savings behavior in order to assess the likely importance of intended bequests for the wealth/income relationship.
Keywords: Adult children; Health Conditions and Status

Observing the Onset of Disability in Older Adults - Sandra L Reynolds; Merril Silverstein (Social Science and Medicine, 2003)
One of the greatest threats to the abilityof older adults to live independently is the onset of disability in activities adults perform in their dailylives, such as dressing, eating, toileting, managing one s money, preparing meals and so on. This article examines the onset of disabilityin older adult Americans using three waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (1993, 1995, 1998; n 4228). We use medical/demographic factors (arthritis, heart disease, diabetes; age, gender, race/ethnicity, wealth), baseline characteristics (affect, cognition, health behaviors, medical insurance), and time-varying covariates (changes in chronic conditions and baseline characteristics) to predict the onset of activities of dailyliving (ADLs) and instrumental activities of dailyliving (IADLs) disability, individuallyand in the aggregate, over time. We find the onset of ADL and IADL disabilityis a complex process, suggesting important roles for medical, demographic, social, psychological, and behavioral triggers, specifically negative affect, higher bodyweight, and bythe lack of vigorous exercise. We also find that individual ADL and IADL impairments are predicted bya varietyof different factors, suggesting that summarymeasures of disability maybe masking a wealth of potentiallyuseful interventions. In general, public health efforts in the area of controlling obesity and treating depressive symptoms should be supported.
Keywords: Disabilities; Health Conditions and Status

The Onset of Health Problems and the Propensity of Workers to Change Employers and Occupations - Messer-Pelkowski, Jodi; Mark C. Berger (Growth and Change, 2003)
Although many studies have investigated how poor health affects hours of work and labor force participation, few have examined the extent to which individuals adapt in order to remain in the labor market. Individuals experiencing health problems may move to different types of work in order to remain in the labor force or to reduce the negative labor market consequences of illness. This paper investigates the movement between employers, and among occupation categories when changing employers, using data from the Health and Retirement Study (HRS). One advantage of the HRS is that its questions on life cycle employment and health patterns permit a long term perspective on job mobility that is unavailable in most other datasets. Workers with health problems are more likely than healthy workers to remain with their current employer than to switch employers. But among those who switch employers, those with health problems are more likely to change broad occupational categories than are healthy workers. While many individuals remain with the same employer after the onset of health problems, many do switch employers and occupations, even in the presence of ADA legislation.
Keywords: Employment and Labor Force; Health Conditions and Status; Time Use

Parsing the Smoking Puzzle: Information, Risk Perception, and Choice - Frank A Sloan; Donald H. Taylor Jr.; V. Kerry Smith (Harvard University Press, 2003)
Examines how perceptions of the risks of smoking are updated as older individuals receive new personalized information and how risk perceptions affect smoking behavior. Highlights the potential for reducing cigarette consumption using a message about a smoker's quality of life at the end of life. Based on data collected in the Health and Retirement Study (HRS), a national panel survey conducted by the University of Michigan's Institute for Social Research on adults aged fifty one to sixty one in the baseline year of the survey (1992), and on information from focus group meetings and interviews with current or former smokers. Surveys government policy and industry advertising with regard to smoking over the past fifty to one hundred years and their effectiveness in influencing cigarette demand. Summarizes existing knowledge and HRS findings on the effects of smoking on mortality and morbidity. Focuses on the survey respondent's assessment of the probability that they will live to age seventy five; examines how well individuals predict their own survival; and explores how people use new information about their own health to update their longevity expectations. Presents new information on smoking cessation and relapse patterns in older adults, paying special attention to the impact of health shocks. Considers whether it is possible to design information messages that mimic the information conveyed to middle aged smokers by personal health shocks and investigates the factors that may make a message especially salient for smokers. Incorporates new findings into an economic analysis of the demand for cigarettes and evaluates the potential impact of a new information policy on daily cigarette consumption of smokers in the sixth and seventh decade of life. Presents policy implications. Sloan is at Duke University. Smith is at North Carolina State University. Taylor is at the Stanford Institute of Public Policy, Duke University. Index.
Keywords: Consumption and Savings; Health Conditions and Status; Healthcare; Methodology; Public Policy; Risk Taking

Patterns of Body Weight in Middle-Aged and Older Americans by Gender and Race, 1993-2000 - Kristi Rahrig Jenkins; Fultz, Nancy H.; Stephanie J. Fonda; Linda A. Wray (Social and Preventative Medicine, 2003)
Objectives: Despite evidence of poor health outcomes associated with excessive weight gain or loss, longitudinal patterns of body weight over the adult life course have not been fully described. This article seeks to address this by examining body weight patterns for middle-aged and older adults.Methods: Panel data from the Health and Retirement Study (HRS) original cohort and the original cohort of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study are used to compare, by social group, characteristics of respondents and non-respondents, baseline weight (1993 and 1994) to year 2000 weight, and explore various weight change trajectories over time.Results: Overall, a greater proportion of middle-aged adults are heavier over time than at baseline and a greater proportion of older adults lose weight over time compared to baseline. Examining the transitions across weight trajectories for all of the social groups suggests considerable variability.Con clusions: These findings suggest that differing physiologic and social or environmental experiences may have implications for body weight patterns. Understanding these patterns by race/ethnicity and gender could provide insight into health disparities among different social groups.
Keywords: Demographics; Health Conditions and Status

Personal Bias in Automobile Claims Settlement - Doerpinghaus, Helen; Schmit, Joan; Jia-Hsing Yeh, Jason (Journal of Risk and Insurance, 2003)
Despite the importance of claims handling practices to consumers and insurers, relatively little research has been done in this area. Our purpose here is to consider one aspect of automobile bodily injury liability claims management: the assignment of fault across parties as judged by the insured defendant's claims adjuster. Because legal fault assessment directly affects whether a defendant is held liable, and if so, for how much, this aspect of claims management is significant. We use accident data from the 1997 Insurance Research Council Closed Claim Survey to test for relationships between fault assessment and gender, age, and state comparative negligence rules. Controlling for actual fault, we find a greater assessment of fault against female, young, and elderly drivers. The results of the study are of interest to insurers seeking to provide better customer service, to consumer advocacy groups interested in claims settlement practices, and to insurance regulators.
Keywords: Employment and Labor Force; Health Conditions and Status

Portfolio Choice and Health Status - Rosen, Harvey S.; Stephen Wu (NBER Working Paper, 2003)
This paper analyzes the role that health status plays in household portfolio decisions using data from the Health and Retirement Study. The results indicate that health is a significant predictor of both the probability of owning different types of financial assets and the share of financial wealth held in each asset category. Households in poor health are less likely to hold risky financial assets, other things (including the level of total wealth) being the same. Poor health is associated with a smaller share of financial wealth held in risky assets and a larger share in safe assets. We find no evidence that the relationship between health status and portfolio allocation is driven by 'third variables' that simultaneously affect health and financial decisions. Further, the relationship between health status and portfolio choice does not appear to operate through the effect of poor health on individuals' attitudes toward risk, their planning horizons, or their health insurance status.
Keywords: Health Conditions and Status; Net Worth and Assets

Profiles of Self-Rated Health in Midlife Adults with Chronic Illnesses - Finnegan, Lorna (University of Illinois at Chicago, Health Sciences Center, 2003)
Five waves of data from the Health and Retirement Study were analyzed to: (1) uncover segments of chronically ill midlife adults who share unique profiles of characteristics that predict self-rated health (SRH), and (2) capture predictor-outcome relationships for each segment. Selected components of the Interaction Model of Client Health Behavior (IMCHB) guided the inclusion of patient characteristics derived from the literature that would likely predict SRH. Self-rated health served as a measure of cognitive appraisal, a key dynamic variable within the IMCHB. In this sample of over 6000 midlife adults with chronic illnesses, three distinct segments were identified through latent class regression. Each segment differed on their cognitive appraisals of health. The Positive Health (PH) segment was characterized by respondents who appraised their health as excellent or very good. In contrast, the Negative health (NH) segment had poor or fair health appraisals. The Average Health (AH) group straddled both sides of this health appraisal and rated their health as fair, good, or very good. Several factors influenced SRH regardless of class membership. In all three segments, respondents who had more than one chronic health condition (relative to those with only one chronic condition), those who engaged in vigorous activity less than three times per week (relative to those who engaged in vigorous activity at least three times per week), those who were current smokers (relative to non-smokers), and/or respondents in the middle net worth quintiles (relative to the highest net worth quintile) were more likely to report poorer levels of SRH. In contrast to the class-independent predictors, several predictors of SRH differed in strength across the three segments. These included: having a health problem that limited paid work, depressed mood, being overweight, not living with a partner, and time since baseline interview. In addition to confirming what is already known about the correlates of SRH and how SRH is manifested in midlife adults with selected chronic illnesses, this study captured unique predictor-outcome relationships for three distinct sample segments. Implications for further research include testing interventions that are designed to match the unique profiles of each of these segments.
Keywords: Health Conditions and Status

Racial Bias in the Assessment of Cognitive Functioning of Older Adults - Richard N Jones (Aging and Mental Health, 2003)
This study was undertaken to determine if the difference in assessed cognition between Black/African-American and White older adults was due differential item functioning (DIF)and/or differences in the effect of background variables. Participants were 15,257 adults aged 50 and older surveyed in the Study of Asset and Health Dynamics of the Oldest Old (AHEAD) and Health and Retirement Study (HRS). The cognitive measure was a modified telephone interview for cognitive status. The analytic strategy was a multiple group structural equation model grounded in item response theory. Results suggest that most (89 )of the group difference could be attributed to measurement or structural differences, the remainder being not significantly different from zero (p 0.193). Most items displayed racial DIF,accounting for most of the group difference. After controlling for DIF, the group difference that remained could be attributed to heterogeneity in the effect of background variables. For example, low education was more deleterious for Black/African-Americans,and high income conferred an advantage only for Whites.These findings underscore the importance of efforts to generate culture-fair measurement devices. However, culture-fair assessments may attenuate, but not eliminate, group differences in assessed cognition due to the incommensurate action of background variables.
Keywords: Demographics; Health Conditions and Status

Racial Differences in Influenza Vaccination Among Older Americans, 1996-2000: Longitudinal analysis of the Health and Retirement Study (HRS) and the Asset and Health Dynamics among the Oldest Old (AHEAD) survey - Truls Ostbye; Donald H. Taylor Jr.; Lee, Ann Marie M.; Gary N. Greenberg; Lynn Van Scoyoc (BMC Public Health, 2003)
Background: Influenza is a common and serious public health problem among the elderly. The influenza vaccine is safe and effective. Methods: The purpose of the study was to determine whether frequencies of receipt vary by race, age group, gender, and time (progress from 1995/1996 to 2000), and whether any racial differences remain in age groups covered by Medicare. Subjects were selected from the Health and Retirement Study (HRS) (12,652 Americans 50 61 years of age (1992 2000)) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (8,124 community-dwelling seniors aged 70 years (1993 2000)). Using multivariate logistic regression, adjusting for potential confounders, we estimated the relationship between race, age group, gender, time and the main outcome measure, receipt of influenza vaccination in the last 2 years. Results: There has been a clear increase in the unadjusted rates of receipt of influenza vaccination for all groups from 1995/1996 to 2000. However, the proportions immunized are 10 20 higher among White than among Black elderly, with no obvious narrowing of the racial gap from 1995/1996 to 2000. There is an increase in rates from age 50 to age 65. After age 70, the rate appears to plateau. In multivariate analyses, the racial difference remains after adjusting for a series of socioeconomic, health, and health care related variables. (HRS: OR = 0.63 (0.55 0.72), AHEAD: OR = 0.55 (0.44 0.66)) Conclusions: There is much work left if the Healthy People 2010 goal of 90 of the elderly immunized against influenza annually is to be achieved. Close coordination between public health programs and clinical prevention efforts in primary care is necessary, but to be truly effective, these services must be culturally appropriate.
Keywords: Demographics; Health Conditions and Status

Risk Ratings that Do Not Measure Probabilities - Viscusi, W.K.; Jahn K. Hakes (Journal of Risk Research, 2003)
Survey questions regarding assessed survival chances are an often-used example of a risk rating scale for eliciting a probability assessment. The responses to such questions do exhibit several properties of probabilities, but differ in some key respects, resulting in relationships which are not only inconsistent with accurate beliefs, but also in which precision is sacrificed for ease of use. The Health and Retirement Study, for example, uses a 0 to 10 scale to measure self-assessed survival probabilities to a particular age. Transformation of these responses for use as a probability results in some patterns that are consistent with a model of imperfect information, or a monotonic transformation of imperfectly perceived risks, but more subtle analysis reveals inconsistencies with either of these theories, suggesting the scale is inappropriate for use as a probability measure. The age-related effects for female respondents are the most salient results that are inconsistent with use of the survey's response scale as representing a probability.
Keywords: Expectations; Health Conditions and Status; Retirement Planning and Satisfaction

The Role of Social Context in the Relationship Between Health and Retirement - Tay K. McNamara (Boston College, 2003)
While many studies have evaluated the effects of health on the retirement decision, these studies have typically paid less attention to the multi-level nature of the context within which individuals and couples make retirement decisions. Using data from waves 1 (1992) through 5 (2000) of the Health and Retirement Study, the present study addresses the multi-level nature of social context and its effects on the relationship between health and retirement. In three linked subanalyses, particular attention was paid to how three core concepts of life course theory (i.e., the social clock, the interdependence of family and work trajectories, and the role of institutions in shaping inequalities) might help to clarify the relationship between health, retirement, and social context. The results of this study indicate that social context, as embodied by internalized norms, social groups, and institutional structures, moderates the relationship between retirement and poor health. More specifically, the analysis of the social clock (micro-level context) indicates that internalized expectations about the correct time to retire influence whether a nonworking person considers themselves retired. Workers in poor health are disproportionately likely to consider themselves "unretired", nonworking but not retired. The analysis of the interdependence of work and family (meso-level context) found that couples jointly evaluated the husbands' and wives' health statuses when making reverse retirement decisions, but not necessarily when making retirement decisions. The analysis of the role of institutions in shaping inequalities focused on the effects of employer policies beneficial to workers in poor health. The effects of two types of policies, employer flexibility in number of hours worked and employer provided health insurance, were examined. While it is not feasible for one study to address all aspects of social context, the present study highlights the relationship between health and retirement on several levels.
Keywords: Adult children; Event History/Life Cycle; Health Conditions and Status; Retirement Planning and Satisfaction

Smoking Cessation and Lifestyle Changes - Gabriel A. Picone; Frank A Sloan (Frontiers in Health Policy Research, 2003)
Keywords: Health Conditions and Status

Socioeconomic Status and Health over the Life Course: Capital as a Unifying Concept - Frytak, Jennifer R.; Harley, Carolyn R.; Finch, Michael D. (Handbook of the Life Course, 2003)
On average, individuals of lower socioeconomic status (SES)—based on education, income, or occupation—have worse health than their higher SES counterparts (Adler, Boyce, Chesney, Folkman, & Syme, 1993; Antonovsky, 1967; Feinstein, 1993; Feldman, Makuc, Kleinman, & Cornoni-Huntley, 1989; House, Kessler, & Herzog, 1990; Kitagawa & Hauser, 1973; Marmot, Shipley, & Rose, 1984; Pappas, Queen, Hadden, & Fisher, 1993; Preston & Taubman, 1994; Townsend & Davidson, 1982). This relationship is best depicted as a gradient in health with a fairly linear trend in better health associated with increasing levels of SES, rather than a threshold effect. Furthermore, this relationship is stratified by age; lower SES individuals begin to experience health problems shortly after adolescence, while higher SES individuals experience little health decline until around retirement age (House et al, 1990, 1994). This life course patterning of SES and health is intriguing since it suggests substantial variation in the ability of each group to sustain good health over the life course.
Keywords: Demographics; Event History/Life Cycle; Health Conditions and Status; Net Worth and Assets

A Study of Health Human Capital - Ippolito, Richard A. (George Mason University School of Law, 2003)
Keywords: Adult children; Demographics; Health Conditions and Status

Transitions to Self-Employment at Older Ages: The Role of Wealth, Health, Health Insurance, and Other Factors - Julie M Zissimopoulos; Lynn A Karoly (RAND Working Paper, 2003)
Relatively little research has been devoted to studying self-employment among older workers although they make up a disproportionate share of the self-employed workforce. This study uses 5 waves of panel data from the Health and Retirement Study to investigate the determinants of labor force transitions to self-employment at older ages. We estimate a multinomial logit model of transitions from wage and salary employment to self-employment, retirement or not working. Results are compared with those found in previous studies. New findings on the impact of health on transitions to self-employment are highlighted.
Keywords: Employment and Labor Force; Health Conditions and Status; Medicare/Medicaid/Health Insurance

Trends in Scores on Tests of Cognitive Ability in the Elderly U.S. Population, 1993-2000 - Willard L Rodgers; Mary Beth Ofstedal; A. Regula Herzog (The Journals of Gerontology: Social Sciences, 2003)
Objective. This study investigates cohort differences in cognitive functioning among Americans aged 70 or older in 1993, 1995, 1998, and 2000. Methods. The study draws on self-respondent data from four waves of the Asset and Health Dynamics Among the Oldest Old Study and the Health and Retirement Study surveys collected between 1993 and 2000. Cognitive performance scores for each of four components (immediate recall, delayed recall, serial 7s, and mental status) and their sum are compared across cohorts, unadjusted and with adjustments for survey design features and demographic characteristics. Results. Unadjusted scores suggest cohort improvements in several components of cognitive functioning between 1993 and 1998, and little change between 1998 and 2000. However, these improvements largely disappear after confounding features of the survey design (changes in age distribution of the sample across waves and prior exposure to the cognitive tests) and changes in the demographic composition of the sample (race, ethnicity, and gender) are adjusted for. Discussion. There appears to have been little improvement of cognitive functioning across recent cohorts of older Americans. However, the study points out the complexities of using panel data to study cohort differences, particularly when the measures of interest are likely influenced by prior wave participation. Future studies based on other data sources are needed.
Keywords: Health Conditions and Status

Understanding the Demand for Private Long-term Care Insurance: A study of contributing factors in the insurance market and public insurance programs - Kang, Hyojin (Cornell University, 2003)
This study examines two possible reasons why few people purchase private long-term care insurance. First, we test if insurance companies cannot distinguish heterogeneous long-term care risk and thus high-risk people dominate the private long-term care insurance market (adverse selection). The second question we ask in the analysis is if Medicaid financing of long-term care crowds out the purchase of private long-term care insurance. The panel data structure from the Health and Retirement Data allows us to test the first hypothesis by comparing post-purchase health trajectories among purchasers and non-purchasers, after controlling for pre-purchase and current health status. We combine individual financial information with state of residence and state-specific Medicaid eligibility limits and impute respondents' expected Medicaid eligibility more precisely than in previous studies, to investigate if the expected Medicaid eligibility is related to the lower probability of the ownership of private long-term care insurance. The panel data from the 1992 - 1998 Health and Retirement Study, the restricted Geocode data, and Medicaid income and asset eligibility limits for individuals and couples by states in 1992 - 1998 are used for the robust probit analysis. Our results provide strong evidence of Medicaid crowd-out: the prospect of satisfying Medicaid income and asset requirements, or asset requirements alone, discouraged respondents from owning private long-term care insurance. Flexible Medicaid income standards in the majority of states with Medically Needy programs may explain why Medicaid still crowds out private insurance among the individuals whose wealth was below but income was above the eligibility limits. The non-linear relationship between wealth and the ownership of private insurance is confirmed. No evidence is found that the respondents have already manipulated their wealth to rely on Medicaid in case of needing long-term care. The post-purchase health of the insured is not found to be worse than that of the uninsured, failing to support the adverse selection hypothesis. However, this lack of support does not rule out adverse selection since insurance companies may effectively screen of high-risk consumers based on their past and current health status.
Keywords: Health Conditions and Status; Medicare/Medicaid/Health Insurance

Wealth, Race, and Mortality - S.A. Bond; Patrick M. Krueger; Rebecca G Rogers; Robert A Hummer (Social Science Quarterly, 2003)
Objective. We explore, first, whether wealth relates to mortality risk independent of income and education, and second, whether wealth closes the black-white gap in U.S. adult mortality while controlling for other socioeconomic and sociodemographic factors. Methods. We employ the Cox proportional hazards models on data from the 1992 wave of the Health and Retirement Study linked to deaths through 1998, to analyze pre-retirement adult mortality in the United States. Results. The findings suggest that broader measures of SES, including wealth, are significant for understanding adult mortality. Further, vastly lower asset holdings among blacks, compared to whites, not only affects their financial wellbeing but also their survival prospects. Conclusions. Research and social policies that aim to understand and close health disparities in the United States may be poorly conceived if they ignore the impact of wealth on premature adult mortality.
Keywords: Demographics; Health Conditions and Status; Net Worth and Assets

Aggregate Risk-Taking and Declining Mortality - Ryan D. Edwards (University of California at Berkeley, Dept. of Economics, 2002)
Just as health and wealth are related, so too are health and financial risk-taking. Although directions of causality are unclear, healthier people are wealthier and take more financial risks. Dierential mortality is therefore a source of bias in cross-sectional measures of portfolio choice through age. As declines in mortality increase lifespans, poorer and previously sicker individuals will increase their share of the surviving population. It follows that the aggregate equity share in the economy may be pulled lower, all other things equal. Panel data from the Health and Retirement Study confirm these insights. Mortality-adjusted age proles of portfolio shares rose less quickly during the 1990s than their unadjusted cross-sectional counterparts. One implication of a declining aggregate equity share due to aging is that public pension programs may need to be recongured over time in order to address the changing characteristics of surviving pensioners. Phasing in a partial privatization of Social Security would be one such option.
Keywords: Health Conditions and Status; Net Worth and Assets; Public Policy

Another Look at Aggregate Changes in Severe Cognitive Impairment: Further investigation into the cumulative effects of three survey design issues - Vicki A Freedman; Aykan, Hakan; Linda G Martin (The Journals of Gerontology Series B, 2002)
OBJECTIVES: This study explored whether previously reported declines in severe cognitive impairment were robust to cumulative effects of potentially confounding survey design issues. METHODS: Using the 1993 Asset and Health Dynamics of the Oldest Old study (n = 7,443) and 1998 Health and Retirement Survey (HRS; n = 7,624) the proportion of persons ages 70 and older with severe cognitive impairment was calculated under various assumptions about item nonresponse, differential loss to follow-up, and the size and composition of the nursing home population. Impairment was measured for self-respondents using a modified version of the Telephone Interview Cognitive Screen; for proxy respondents ratings of memory and judgment were used. Chi-square tests were adjusted to account for complex survey designs. RESULTS: Ignoring loss to follow-up, excluding nursing home residents, and assigning a low score to those refusing subscales yielded a statistically significant decline in severe cognitive impairment from 5.8 in 1993 to 3.8 in 1998, or an average annual decline of 6.9 . When cumulative effects of survey design issues were considered and design effects incorporated into statistical tests, statistically significant declines persisted, albeit at a reduced average annual rate, ranging from 2.5 to 6.9 per year. DISCUSSION: Previously reported improvements in severe cognitive impairment appear to be robust to a variety of specifications. Replication with future waves of the HRS and other data is warranted.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology; Other

Changes in Self-Assessment of Health: Comparison of Self-Perception and Self-Ratings Score Measures Among Young-Old Persons - Namkee G Choi (Journal of Gerontological Social Work, 2002)
Most geriatric screening devices include the self-ratings of health scale as a useful collateral source of information on elders' health status and their need for social and health services. In this study, I reviewed extant research findings on subjective assessment of health and then compared the congruence and discrepancy between the commonly used self-ratings scale and the less frequently used self-perception scale as measures of longitudinal stability or changes in health status among the young-old. Analysis of data from the 1992 and 1994 waves of the Health and Retirement Study (HRS) shows that the restricted range of the self-ratings scale poses a limitation when the scale is used to measure changes in health status over time. It was also found that the self-ratings scale may reflect a more horizontal, social-comparison dimension and that the self-perception measure may reflect a more vertical, temporal-comparison dimension in subjective assessment of longitudinal changes in health status. Social workers need to be aware of the strengths and limitations of both measures when they use them. Reprinted by permission of the publisher.
Keywords: Health Conditions and Status

COBRA, Spouse Coverage, and Health Insurance Decisions of Older Households - Mark C. Berger (Journal of Forensic Economics, 2002)
We use the Health and Retirement Study (HRS) to model the health insurance coverage decisions of older households over time. We estimate coverage decisions as functions of eligibility for various types of health insurance, including the Consolidated Omnibus Budget Reconciliation Act (COBRA) and coverage through current employers of household members, and other characteristics. A bivariate probit model is used to jointly estimate the coverage decisions of husbands and wives and to allow for correlation between unobservable characteristics of the spouses. We use the results to simulate changes in household health insurance coverage that result from events that enable the household to qualify for COBRA coverage.
Keywords: Consumption and Savings; Employment and Labor Force; Health Conditions and Status; Healthcare; Insurance; Medicare/Medicaid/Health Insurance; Public Policy

Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People - Kala M. Mehta; Kristine Yaffe; Kenneth E Covinsky (Journal of the American Geriatrics Society, 2002)
OBJECTIVES: Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort. DESIGN: Prospective cohort study. SETTING: A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old. PARTICIPANTS: Five thousand six hundred ninety-seven participants (mean age 77, 64 women, 86 white) followed from 1993 to 1995. MEASUREMENTS: Cognitive impairment and dpressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity. CONCLUSIONS: In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline.
Keywords: Health Conditions and Status

Critique of Cognitive Measures in the Health and Retirement Study (HRS) and the Asset and Health Dynamics among the Oldest Old (AHEAD) Study - Margie E Lachman; Avron Spiro III (2002)
Keywords: Health Conditions and Status; Methodology

Does Money Buy Better Health? Three essays examining the causes of socioeconomic differentials in health after midlife - Berry, Brent M. (University of Michigan, 2002)
Does money buy better health? This dissertation seeks to more clearly discern whether social policy aimed at reducing health disparities is likely to be effective through programs that transfer income and wealth to needy adults in their latter working age years. First, I discuss explanations for why money might matter for health. Competing explanations emphasize patterned responses to social structural inequalities and individual health investments. The assumptions underlying these perspectives can be expressed in the language of experiments. Differences reduce to assumptions about the importance of unobserved heterogeneity bias, and the relative importance of fixed, time-varying, and health-related factors as sources of this bias. Second, I investigate the importance of money for health using a sample of 7,400 respondents and their age eligible spouses nearing or undergoing the transition into retirement. Four waves of data from the Health and Retirement Study (HRS) are used to estimate the influence of individual income, wealth, and education on three health outcomes: self-rated health, depressive symptoms, and functional limitations. Chapter Two seeks to more accurately compare the true effect of education with money on self-reported health. More so than education, income and wealth over the work career are influenced by health and other factors. Adjusting for family background and feedbacks from prior health to income reduces estimates of income influence by 75% or more and wealth by about 50%. The effect of education is also diminished, but only by 20 to 30%. These findings suggest that the long-term influence of psychological skills and social environments derived from education outweigh the health benefit of greater economic resources in the peak earning years of middle age. Chapter Three focuses on minimizing unobserved heterogeneity bias due to fixed confounders. Results suggest that income and wealth boosts over several years will have only small influences on self-reported health. Chapter Four examines unexpected life events as sources of income variation, to set up natural experiments. Unexpected job loss, union membership, and occupation are instrument variables. Compared to unadjusted estimates, these alternative estimates suggest only a very small impact of income and wealth on self-reported health.
Keywords: Demographics; Health Conditions and Status

Education, Wealth, and Cognitive Function in Later Life - Kathleen A. Cagney; Diane S. Lauderdale (The Journals of Gerontology Series B, 2002)
Population-based studies of health often use education as the sole indicator of socioeconomic status (SES); the independent contributions of education and other SES covariates are rarely delineated. Using Wave 1 of the Asset and Health Dynamics Among the Oldest Old study, the authors examined the extent to which educational attainment influences performance on three separate domains fo cognitive status by race and Latino ethnicity and introduced controls for wealth and household income. Results indicate that the education effect is minimally weakened after adjusting for wealth: the wealth effect, however, is greatly attenuated after adjusting for education. Blacks and Whites exhibited a similar education-cognition relationship; Latino elderly did not experience commensurate gains in cognitive function with increasing education. Results suggest that although the education-cognition relationship may in part reflect an SES gradient, the association is more likely due to the process and consequences of education itself.
Keywords: Demographics; Health Conditions and Status

The Effect of Health Events and Health Insurance on Couples' Labor Supply Decisions - Courtney Coile (Wellesley College, 2002)
Health status and the availability of retiree health insurance are well known to be crucial factors in retirement decision-making. However, researchers have typically used an individual framework to model the retirement decision and have often ignored the potentially important role of the spouse s health status and of potential access to health insurance in retirement through the spouse in explaining retirement behavior. This paper follows McClellan (1998) in focusing on negative health events rather than health status, as the latter may be endogenous with respect to retirement, but extends the previous work to look at the effect of health shocks on the spouse s labor supply.
Keywords: Adult children; Employment and Labor Force; Health Conditions and Status; Medicare/Medicaid/Health Insurance

Effects of Cognition on Driving Involvement Among the Oldest Old: Variations by Gender and Alternative Transportation Opportunities - Freund, Barbara; Maximiliane E Szinovacz (The Gerontologist, 2002)
This study explored the impact of cognition and the availability of other drivers on driving restriction and cessation among older adults. Survey data from the first wave of the Asset and Health Dynamics Among the Oldest Old data were analyzed, using multinomial logistic regressions. Cognitive impairment is associated with driving restriction and cessation, although a noteworthy minority of mildly and severely cognitively impaired individuals continue to drive. Partner's driving and involvement and presence of other drivers in the household moderated the effect of cognition on driving restriction and cessation. The decision processes surrounding an individual's restricting or stopping driving are complex and may include consideration not only of competence, but also of sense of self-worth and relationship with a partner.
Keywords: Health Conditions and Status

Effects of Food and Health Spending Patterns on the Health of the Elderly - Gomez, Miguel I.; Ranney, Christine K. (Cornell University, Dept. of Applied Economics and, 2002)
Examines linkages between food and health spending patterns, income, and health status of the elderly. Links these relationships to food insecurity and expenditures on nutraceuticals. Methodology includes simultaneous estimation of expenditure systems and health production functions. Preliminary results indicate simultaneity between health production function and spending patterns throughout the life cycle.
Keywords: Health Conditions and Status

Endowments at Birth and Adult Health: Childhood Socioeconomic Factors and Heart Disease - Ippolito, Richard A. (George Mason University School of Law, 2002)
Children born in lower socioeconomic strata are more likely to engage in consumption habits that are deleterious to adult health, less likely to attain higher levels of education, and more likely to have lower income and wealth as adults. More recent epidemiological studies suggest a perhaps more profound idea, that an adult s ailments may depend importantly on his physical condition on the day of his birth. Owing to conditions that characterize their prenatal period and early infancy, children born to families of lower socioeconomic strata carry a permanent marker for higher rates of adult heart disease, and perhaps other ailments as well. In this paper, I report results from the Health and Retirement Survey that are consistent with this hypothesis. Accounting for adult consumption habits, adult socioeconomic status, and numerous other potentially confounding variables, the results show that men who are shorter and born to fathers with less education are more likely to develop various manifestations of heart disease in middle age. The data suggest that adult health effects from childhood are disease and gender specific. While the data leave open the pathway by which lifetime health effects are coded early on, the results suggest a potentially high return on resources devoted to ensuring health-conscious behavior during pregnancy and healthy diets during infancy.
Keywords: Adult children; Demographics; Health Conditions and Status

Excess Alcohol Consumption and Health Outcomes: A 6-Year Follow-Up of Men Over Age 50 from the Health and Retirement Study - Perreira, Krista M.; Frank A Sloan (Addiction, 2002)
Aims This study examined the association of problem drinking history and alcohol consumption with the onset of several health conditions and death over a 6-year follow-up period. Setting We analyzed two waves of longitudinal data on men over 50 who participated in the Health and Retirement Study, a nationally representative sample of people aged 51 61 and their spouses living in the United States in 1992. Measurements Five types of health outcomes mortality, general health, functional status, cognitive status, and mental health were examined. Drinking categories were based on average drinks per day (0, 1, 1 2, 3 4, 5 ), with 5 defined as very heavy drinking . Problem drinking history was identified as 2 affirmative responses to the CAGE questionnaire. We controlled for smoking and other factors at baseline. Findings Over the 6-year follow-up period, very heavy drinking at baseline quadrupled the risk of developing functional impairments (OR: 4.21 95 CI: 1.67, 10.61). A problem drinking history increased the onset of depression (OR: 1.67 95 CI: 1.02, 2.74), psychiatric problems (OR: 2.15 95 CI: 1.47, 3.13) and memory problems (OR: 1.71 95 CI: 1.14, 2.56). Heavy drinking among mature adults was not associated with increased incidence of other adverse health events (i.e. angina, cancer, congestive heart failure, diabetes, myocardial infraction, lung disease or stroke). Conclusion Very heavy drinking and a problem drinking history greatly increased rates of onset of functional impairments, psychiatric problems and memory loss in late middle age for men who had not experienced these impairments at their initial interview.
Keywords: Health Conditions and Status

Florida Migration in the AHEAD Study, 1993-1995: A note on the flight of the oldest retirees - Hays, Judith C.; Charles F Longino (Research on Aging, 2002)
Explores the migration patterns of people older than age 70. If the life course perspective on retirement migration is correct, then this older category should be somewhat less inclined to enter the key national destination states and more likely to be moving toward the usual sending states, unlike younger retirees. The Asset and Health Dynamics Among the Oldest Old (AHEAD) Study is critical to this study goal because it contains an oversample of Florida residents older than age 70. Respondents were interviewed in 1993 and again in 1995. The older movers who were identified tend to move locally, or within the state, but those who migrate across state lines are more often leaving Florida than entering it, as suggested by the life course theory.
Keywords: Demographics; Health Conditions and Status

Gender and Ethnic/Racial Disparities in Health Care Utilization Among Older Adults - Dorothy D Dunlop; Larry M Manheim; Song, Jing; Rowland W Chang (The Journals of Gerontology: Social Sciences, 2002)
OBJECTIVE: We examine the role of economic access in gender and ethnic/racial disparities in the use of health services among older adults. METHODS: Data from the 1993-1995 study on the Asset of Health Dynamics Among the Oldest Old (AHEAD) were used to investigate differences in the 2-year use of health services by gender and among non-Hispanic White versus minority (Hispanic and African American) ethnic/racial groups. Analyses account for predisposing factors, health needs, and economic access. RESULTS: African American men had fewer physician contacts; minority and non-Hispanic White women used fewer hospital or outpatient surgery services; minority men used less outpatient surgery; and Hispanic women were less likely to use nursing home care, compared with non-Hispanic White men, controlling for predisposing factors and measures of need. Although economic access was related to some medical utilization, it had little effect on gender/ethnic disparities for services covered by Medicare. However, economic access accounted for minority disparities in dental care, which is not covered by Medicare. DISCUSSION: Medicare plays a significant role in providing older women and minorities access to medical services. Significant gender and ethnic/racial disparities in use of medical services covered by Medicare were not accounted for by economic access among older adults with similar levels of health needs. Other cultural and attitudinal factors merit investigation to explain these gender/ethnic disparities.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology; Other; Women and Minorities

Good Marriages Gone Bad: Health mismatches as a cause of later-life marital dissolution - Sven E. Wilson; Waddoups, S.L. (Population Research and Policy Review, 2002)
This study explores the impact of health status on marital dissolution for couples in late mid-life. A key feature of the empirical framework is that it incorporates the interaction of health between the spouses. This specification allows not only a general test of whether health matters but also a specific test of an important implication of cost-benefit models of marriage dissolution. In particular, cost-benefit models imply that marriages exhibiting a health mismatch (where one partner has substantially better health than the other one) are more likely to get divorced than couples who have similar health (whether good or bad). Using a Cox proportional hazards model, we test this hypothesis by estimating the impact of different spousal health combinations on the probability of marital dissolution (as indicated by separation). Data are taken from four waves of the Health and Retirement Study (19921998) and consist of 4, 241 couples where at leas t one spouse is between the ages of 51 and 61 in 1992. We do find evidence for the health mismatch hypothesis, but only among couples in which both couples report their marriages to be very satisfying. Among other couples, no effect is found. This suggests that health is of minor consequence for already unhappy couples, but health mismatches pose a significant risk of dissolution to happy couples within this age cohort, possibly because of the unexpected nature of poor health at a relatively young age.
Keywords: Adult children; Health Conditions and Status

Health Insurance and Labor Supply: Evidence from Hypothetical Shocks to Wealth - Matthew D. Shapiro; Miles S Kimball (Ann Arbor, MI, University of Michigan, 2002)
Keywords: Employment and Labor Force; Health Conditions and Status; Medicare/Medicaid/Health Insurance; Net Worth and Assets

Health Insurance and Mammography: Would a Medicare buy-in take us to universal screening? - Donald H. Taylor Jr.; Lynn Van Scoyoc; Hawley, Sarah T. (Health Services Research, 2002)
Objective. To determine whether health insurance expansioins via a Medicare buy-in might Plausibly increase mammography screening rates among women aged 50-64.Data Sources. Two waves of the Health and Retirement Study (HRS) (1994, 1996).Study Design. A longitudinal study with most explanatory variables measured at the second wave of HRS (1994); receipt of mammography, number of physician visits, and breast self exam (BSE) were measured at the third wave (1996).Data Extraction. Our sample included women aged 50-62 in 1994 who answered the second and third HRS interview (n=4,583).Principal Findings. From 1994 to 199,6, 72.7 percent of women received a mammogram. Being insured increased mammography in both unadjusted and adjusted analyses. A simulation of universal insurance coverage in,this age group increased mammography rates only to 75-79 percent from the observed 72.7 percent. When we accounted for potential endogeneity of physician visits and BSE to mammo graphy, physician visits remained a strong predictor of mammography but BSE did not.Conclusion. Even in the presence of universal coverage and very optimistic scenarios regarding the effect of insurance on mammography for, newly insured women, mammography rates would only increase a small amount and gaps in screening would remain. Thus, a Medicare buy-in could be expected to have a small impact on mammography screening rates.
Keywords: Health Conditions and Status; Medicare/Medicaid/Health Insurance; Women and Minorities

Long-Term Care, Formal Home Health Care, and Informal Care - Byrne, David; Goeree, Michelle S.; Hiedemann, Bridget; Steven N. Stern (University of Virginia, Dept. of Economics, 2002)
Keywords: Health Conditions and Status; Healthcare

Low Cognitive Performance, Comorbid Disease, and Task Specific Disability: Findings from a nationally representative survey - Caroline S Blaum; Mary Beth Ofstedal; Jersey Liang (The Journals of Gerontology: Medical Sciences, 2002)
Background. This research evaluated the association of low cognitive performance with both chronic diseases and conditions, and with difficulties in a broad array of task-specific functioning and disability measures in older adults living in the community. Methods. Data were from the first wave of the Assets and Health Dynamics Among the Oldest-Old Study, a national panel survey of individuals age 70 and older (n 6600 age-eligible self-respondents). Low cognitive performance (LCP) was defined as scores in the lowest (poorest performing) 25th percentile of a cognitive performance scale. The associations of LCP with prevalent chronic diseases and conditions and with limitations in 14 tasks (strength and mobility, instrumental activities of daily living, and activities of daily living) were evaluated. Associations of LCP and task limitations were adjusted for potential modifiers and confounders, including demographic characteristics (age, gender, race), educational attainment, chronic diseases, depressive symptoms, and sensory impairments. Data were weighted to account for complex sample design and nonresponse. Results. More than one third of people with LCP had three or more coexisting diseases and conditions. The unadjusted associations of LCP with task functioning were attenuated after covariate adjustment, but even after adjustment, LCP remained significantly and independently associated with functioning problems in 9 of 14 tasks (borderline with four more), including mobility tasks. Conclusions. Low cognitive performance, regardless of its relationship to clinical dementia, coexists with multiple chronic diseases and conditions. It is independently associated with a broad array of functioning difficulties, even after controlling for demographic characteristics, educational attainment, and chronic conditions. Chronic diseases and conditions, however, attenuate the relationship between LCP and some task difficulties. LCP should be considered an important comorbid condition associated with both chronic diseases and disability that substantially increases the health burden of many older adults who are poorly equipped to handle it.
Keywords: Disabilities; Health Conditions and Status

Mental Health and Labor Market Outcomes - Steffick, Diane E. (University of Michigan, 2002)
This dissertation consists of three essays on the relationship between mental health (the Center for Epidemiologic Studies Depression Scale) and labor market behaviors--employment, hours worked, wages, welfare program participation, and retirement. Using the National Longitudinal Survey of Youth 1979 cohort (individuals in their thirties), I find that high levels of psychological distress are associated with a lower probability of employment for men and women, fewer hours worked among men that work, and lower wages among women that work. Women with high levels of psychological distress were more likely to use welfare and had longer spells of recipiency. Using panel data techniques, these effects are examined across time and remain significant as far as five years in the future. The third chapter uses the Health and Retirement Survey to examine the relationship between psychological distress and early retirement. Among men and women aged 50 to 61 at baseline, those with above-average levels of psychological distress were more likely to not be working at baseline and, if working, to leave the labor force during the following six years. The analysis uses the Stock and Wise option value of work theoretical framework, and the retirement decision is modeled as a sequential probit, with decisions across years correlated through an individual random effect. Comparisons are made to the effect of physical health (a scale of self-reported functioning limitations), which has a larger impact on labor force withdrawal than psychological distress. The time series properties of physical and mental health are estimated by a model with a persistent component (following an autoregressive process of order one) and a transitory component. Physical and mental health have similar persistent components but mental health has a more variable transitory component. Physical and mental health have similar indirect effects on retirement, except for earnings where physical health has a larger effect. These differences are not large enough to explain the larger impact of physical health on retirement timing. The theoretical model leaves one explanation—that physical limitations have a larger negative impact on the non-pecuniary utility from work relative to retirement than psychological distress.
Keywords: Employment and Labor Force; Health Conditions and Status

Older Workers and their Selection of Partial and Full Retirement: Evidence from Health and Retirement Study - Kim, Haejeong (Purdue University, 2002)
The purpose was to investigate older workers' retirement transitions by examining factors associated with partial retirement and full retirement during a four-year period. The study used data from three waves of the Health and Retirement Study. The sample consisted of 3,268 primary respondents who were working full time in Wave 1. A conceptual model was developed based on the life-cycle retirement model, the lifecycle income hypothesis, disengagement theory, activity theory, continuity theory, lifecourse perspectives, role theory, and the findings of previous research on retirement behavior. Binary logit regression and multinomial logit regression analyses were employed for model estimation. Major findings from the multinomial logit using baseline predictors to examine partial and full retirement in Wave 3 are 1) unearned income, Individual Retirement Account and Keogh plans positively impact the likelihood of partial retirement versus full-time work, while the ownership of defined benefit plans and the ownership of defined contribution plans negatively impact partial retirement versus full-time work; 2) the number of chronic conditions positively impact the likelihood of partial retirement; 3) perceived age discrimination, age, male, and a college degree are positively associated with the likelihood of partial retirement; 4) the expected age of Social Security benefit receipt is negatively related to the likelihood of full retirement versus full time work, while the ownership of defined benefit plans, the ownership of both defined benefit and defined contribution plans, the ownership of IRA and Keogh plans, the ownership of health insurance after retirement are positively related to the likelihood of full retirement; 5) excellent and good health, and the meaning of work is more important are negatively associated with the likelihood of full retirement; and 6) age is positively associated with the likelihood of full retirement. The conflicting effects of pension plans on partial retirement and full retirement show that pension are a stimulus to encourage working although part-time, while pension plans are important as retirement incentives for the full retirement decision. Theoretical, empirical, and practical implications are presented based on the findings.
Keywords: Employment and Labor Force; Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction

Research in Population Health - Jones, Nathan Reed (University of Pennsylvania, 2002)
This dissertation presents three chapters on population health and mortality risk using cause of death and underlying conditions data as well as longitudinal studies that include a wide spectrum of individual, household, and community variables. Although the three studies contained in this dissertation are not directly linked topically, they share a concern about the role of smaller components of a population to the mortality dynamics of the population as a whole. Each of the three papers builds on previous research to provide a level of detail or innovation in measurement to improve understanding of mortality dynamics and their effects on the population of interest. In the first chapter, I hold wealth rank in the poorest and richest global wealth quintiles constant over time to provide estimates of the deaths by primary cause group in 1970, 1990, and 2020. I also provide projections of deaths by cause for the richest and poorest countries in 2020 for twenty-one causes of death. The mortality structure among the poorest countries in the world continues to be dominated by infectious causes of death despite global estimates that suggest the epidemiologic transition has progressed to an advanced stage. The second chapter describes age-graded mortality risk for sub-groups of the U.S. population taking into account several demographic, economic, and health characteristics. Using data from different representative cohorts, I estimate age-specific relative risks of death associated with different health, socioeconomic, marital status, and behavioral characteristics to the mean risk of death. The third chapter describes a method for estimating variance in individual mortality risk based on observed characteristics using representative cohorts of the Health and Retirement Study (HRS). I compare distributions of predicted mortality risk to estimates of the degree of population-level heterogeneity in previous studies that have used parameterized frailty models for unobserved heterogeneity in mortality. Findings in this chapter show that the coefficient of variation for estimates of individual mortality risk decrease with age, thus suggesting that the inverse gaussian distribution may be more appropriate in frailty models than the gamma distribution, which implies a coefficient of variation that is constant with age.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology

The socio-economic and Health Differences in Parents' Provision of Help to Adult Children: A British-USA Comparison - John C Henretta; Emily M D Grundy; Harris, Susan (Ageing and Society, 2002)
Transfers of assistance from older to younger family members are an important, though often ignored, component of intergenerational exchanges. The ability to help younger family members, either financially or practically, may be influenced by the health and socio-economic status of older parents, but very little is known about these patterns. This article examines the effects of socio-economic and health status on the help that late mid-life parents in Britain and the United States give their children with money, domestic tasks, and grandchild care. Results for the different types of family support yield three main findings. First, there are relatively few differences between Britain and the USA in the factors affecting the provision of support. Secondly, socio-economic factors appear to be more important among married respondents while health is more important among the unmarried. Thirdly, children's co-residence has greater effects on the provision of domestic task help in Britain than in the United States.
Keywords: Adult children; Demographics; Health Conditions and Status

Study: Marriage Builds Partners in Health - USA Today (USA Today, 2002)
Keywords: Adult children; Health Conditions and Status

Who Expects to Continue Working After Age 62? The retirement plans of couples - Pienta, Amy M.; Mark D Hayward (The Journals of Gerontology: Social Sciences, 2002)
OBJECTIVES: This study examines the individual, spousal, and household characteristics associated with the retirement expectations of husbands and wives. METHODS: Using data from the 1992 Health and Retirement Study, subjective probabilities of working full-time after reaching age 62 and age 65 are used to measure retirement expectations. The retirement expectations of husbands and wives are modeled simultaneously using a joint-generalized least-squares approach. RESULTS: Within a marriage, retirement expectations are shaped by individual, spousal, and household characteristics. We observe some gender differences in cross-spousal influence with wives' retirement expectations being more influenced by husbands' resources and constraints than vice versa. Nonetheless, individual and household factors associated with retirement expectations are widely shared by husbands and wives. DISCUSSION: Husbands and wives both respond to individual and joint constraints and opportunities when planning for retirement. Findings support that there is considerable overlap in retirement planning of husbands and wives during early parts of the retirement decision-making process. However, inequity in cross-spousal influences is a defining characteristic of retirement decision making. Implications for both policy makers and practitioners are briefly discussed.
Keywords: Adult children; Demographics; Employment and Labor Force; Expectations; Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction; Risk Taking

Adapting to Heart Conditions: A Test of the Hedonic Treadmill - Stephen Wu (Journal of Health Economics, 2001)
This paper tests the hypothesis of hedonic adaptation by analyzing the role that a history of heart problems has on the ability to deal with future heart conditions. The results show that those who have had a heart condition in the past are less likely to report worse self-assessed health and emotional health due to the onset of a new condition than those who have not previously had exposure to heart trouble. The results are fairly supportive of the notion of a hedonic treadmill.
Keywords: Consumption and Savings; Disabilities; Health Conditions and Status

Aggregate Changes in Severe Cognitive Impairment Among Older Americans: 1993 and 1998 - Vicki A Freedman; Aykan, Hakan; Linda G Martin (The Journals of Gerontology: Social Sciences, 2001)
OBJECTIVES: This study explored whether improvements in cognitive functioning occurred during the 1990s among older Americans and investigated several possible explanations for such changes. METHODS: Using the 1993 Asset and Health Dynamics of the Oldest Old study (N = 7,443) and 1998 Health and Retirement Survey (N = 7,624), this study examined aggregate changes in the proportion of the noninstitutionalized population aged 70 and older with severe cognitive impairment. Impairment was measured for self-respondents using a modified version of the Telephone Interview Cognitive Screen; for proxy respondents, ratings of memory and judgment were used. Logistic regression was used to investigate potential explanations for aggregate changes. RESULTS: The percentage of older Americans with severe cognitive impairment declined from 6.1 in 1993 to 3.6 in 1998 (p .001). The decline was statistically significant among self-respondents but not among those with proxy interviews. Improvements between 1993 and 1998 were not explained by shifts in demographic and socioeconomic factors or by changes in the prevalence of stroke, vision, or hearing impairments. DISCUSSION: As a group, older persons, especially those well into their 80s, appear to have better cognitive functioning today than they did in the early 1990s.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology

Anticipated and Actual Bequests - Michael D Hurd; James P Smith (Themes in the Economics of Aging, 2001)
This paper uses data on anticipated bequests from two waves of the Health and Retirement Study and the Asset and Health Dynamics of the Oldest Old (AHEAD), and on actual bequests from AHEAD. Actual bequests were measured in exit interviews given by proxy respondents for 774 AHEAD respondents who died between waves 1 and 2. Because the exit interview is representative of the elderly population, the distribution of estate values is quite different from that obtained from estate records, which represent just a wealthy subset of the population. Anticipated bequests were measured by the subjective probability of leaving bequests. Between waves 1 and 2, increases in bequest probabilities were associated with increases in the subjective probability of surviving, increments in household wealth, and widowing while out-of-pocket medical expenses reduced the likelihood of a bequest. By comparing bequest probabilities with baseline wealth we were able to test a main prediction of the life-cycle model, that individuals will dissave at advanced old-age. The AHEAD respondents anticipate substantial dissaving before they die.
Keywords: Adult children; Consumption and Savings; Demographics; Event History/Life Cycle; Health Conditions and Status

Antihypertensive Medication Use in Hispanic Adults: A comparison with Black adults and White adults - Joseph J Sudano; David W. Baker (Medical Care, 2001)
BACKGROUND. Variations in awareness, treatment, and control of hypertension among different racial/ethnic groups have been widely reported. It is unclear whether these differences are explained fully by differences in socioeconomic status, insurance coverage, health status, and health behaviors, or whether these differences indicate that racial/ethnic subgroups have unique barriers to hypertension control. OBJECTIVES. Determine whether there are significant differences between racial/ethnic groups in medication use for hypertension after adjusting for potentially confounding variables. RESEARCH DESIGN. Cross-sectional analysis of the 1992 Health and Retirement Study. SUBJECTS. 2450 non-Hispanic white, 939 non-Hispanic black, and 345 Hispanic participants, ages 51 to 61, reporting a history of hypertension. MEASURES. Self-reported current antihypertensive medication use. We used logistic regression to adjust for demographics, socioeconomic status, health status, insurance, and health risk behaviors. RESULTS. 63.6 of white adults, 72.6 of black adults, and 52.5 of Hispanic adults reported current medication use to control hypertension (P 0.001 across all three groups). In stratified analysis, the lower rate of use for Hispanic adults was consistent regardless of gender, insurance coverage, or health status. After controlling for all variables, the adjusted prevalence for Hispanic adults was 50.8 and 73.3 for black adults. CONCLUSIONS. The differences in antihypertensive medication use between white adults, black adults, and Hispanic adults, particularly the markedly lower rates among Hispanic adults, are not explained by differences in demographics, socioeconomic status, health insurance coverage, health status, or health risk behaviors. Alternative explanations for these results and areas for future research and intervention are explored.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology; Risk Taking; Women and Minorities

Are Smokers Too Optimistic? - Frank A Sloan; Donald H. Taylor Jr. (The Economic Analysis of Substance Use and Abuse: The Experience of Developed Countries and Lessons for Developing Countries, 2001)
Keywords: Consumption and Savings; Health Conditions and Status

Are There Unhealthy Cities? The Impact of Metropolitan Context on Health in Late Middle Age - Mary Elizabeth Hughes (Southern Sociological Society, 2001)
Recently, several authors have argued that individual health is shaped in part by the characteristics of the cities in which individuals live. Particular attention has been devoted to metropolitan income distribution, residential segregation, and employment conditions. While these ideas are compelling, they have yet to be adequately tested. I expand on previous research in four ways. First, I use multilevel data that includes characteristics of both individuals and the cities in which they live. Second, my data are longitudinal, tracing the health impact of metropolitan context over a 4-year period. Third, I examine several dimensions of health. Finally, I focus on a narrow age range. Data for my analysis are drawn from waves 1-3 of the Health and Retirement Study, an ongoing longitudinal survey of persons born between 1931 and 1941. I limit my analysis to respondents living in metropolitan areas, yielding an effective sample size of approximately 6,900 persons. I appended data characterizing respondents' metropolitan areas, drawn from a variety of sources, to their individual data records. I use hierarchical linear modeling to examine the impact of metropolitan characteristics on self-rated health, presence of a mobility limitation, depressive symptoms, and presence of a chronic disease.
Keywords: Demographics; Health Conditions and Status; Healthcare

Balancing Elder Care Responsibilities and Work: The Impact on Emotional Health - Lee, Jo Ann; Walker, Matthew; Shoup, Richard (Journal of Business and Psychology, 2001)
As the elderly population over 85 and the amount of women in the workforce both rise there is an increasing number of persons that must divide their time between working and caring for an elderly relative. These researchers hypothesize that (1a) the relationship between caregiver status and emotional health will be resultant on whether or not the respondent is employed; (1b) those people that are caregivers and employed are expected to have more problems with emotional stability; (2) these problems will grow as the caregiver becomes more involved with the elderly person; and (3) male caregivers are expected to fair better, emotionally, than female caregivers. They found mixed support for hypothesis 1a and no support for hypothesis 1b. However, hypothesis 2 was supported as more emotional difficulties evolved when a caregiver became more involved with the elderly person. Hypothesis 3, found support in that depression was more prevalent in the women caregivers than the men, but other emotional factors did not show significant relationships.
Keywords: Adult children; Employment and Labor Force; Health Conditions and Status; Healthcare

Balancing Retirement Security with the Needs of Frail Parents: Caregiving, Financial Transfers, and Work by Women at Midlife - Richard W. Johnson; LoSasso, Anthony T. (North American Actuarial Review, 2001)
Caring for frail elderly parents can interfere with work responsibilities. People who provide care to their parents may need to take time off from work or retire altogether. However, reductions in labor supply at midlife can have serious implications for retirement wealth and, as a result, on economic well-being in later life. This paper examines how family support for the elderly can affect retirement savings by examining the relationship between labor supply, time help to parents, and financial assistance to parents. Using data from the Health and Retirement Study on a nationally representative sample of women ages 53–63, we found that women who helped their parents with personal care assistance worked significantly fewer hours than did those who did not help their parents, whereas those who provided financial assistance worked significantly more hours. Although few persons at midlife presently spend substantial amounts of time helping their elderly parents in any given year, for those who do, the costs can be high. Pressures on families are likely to mount in the near future as falling mortality and fertility rates continue to increase the proportion of the population that is very old and as women continue to play more important roles in the labor market.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Women and Minorities

Betwixt and Between: Targeting coverage reforms to those approaching Medicare - Dennis G. Shea; Pamela F. Short; M. Paige Powell (Health Affairs, 2001)
Recent Medicare buy-in proposals agree on setting eligibility at age sixty-two but disagree on linking eligibility to loss of employer insurance or ability to pay. We examine arguments for targeting incremental coverage for older Americans in these ways. While access to retiree health insurance is declining, we question whether targeting loss of employer insurance can address many older Americans' insurance problems. Furthermore, focusing on persons ages sixty-two to sixty-four misses a large group of persons in poor health with limited resources. Efforts to improve coverage for older Americans should consider trade-offs between defining eligibility by age versus ability to pay.
Keywords: Demographics; Health Conditions and Status; Healthcare; Income; Insurance; Medicare/Medicaid/Health Insurance; Methodology; Net Worth and Assets

Breast Cancer Survival, Work, and Earnings - Cathy J. Bradley; Bednarek, Heather; David Neumark (NBER Working Paper, 2001)
Relying on data from the Health and Retirement Study, we examine differences between breast cancer survivors and a non-cancer control group in employment, hours worked, wages, and earnings. Overall, breast cancer has a negative impact on the decision to work. However, among survivors who work, hours of work and, correspondingly, annual earnings are higher compared to women in the non-cancer control group. These findings suggest that while breast cancer has a negative effect on women's employment, breast cancer may not be debilitating for those who remain in the work force. We explore numerous possible biases underlying our estimates especially selection based on information in the Health and Retirement Study, and examine related evidence from supplemental data sources.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Methodology; Other; Retirement Planning and Satisfaction; Social Security; Women and Minorities

Capital and Health Status in Near-old Adults - Frytak, Jennifer R. (University of Minnesota, 2001)
Background. The existence of socioeconomic status (SES) differentials in health status has been widely recognized in the literature; the differentials appear to be widest in near-old adults (ages 55-64). Different disciplines have proposed a variety of explanatory mechanisms thought to account for the relationship between SES and health. However, no consensus has been reached in the literature regarding the best explanation for SES differentials in health. Objective. This study investigates how different types of financial, human, and social resources-defined hereafter as capital are associated with producing health in low versus high SES groups. Data source. Wave 1 (1992) and Wave 2 (1994) of the Health and Retirement Study. Study design. This research attempts to combine economic and sociological perspectives into a capital-based approach to exploring SES differentials in health. Measures of financial, human, and social capital were developed. The sample was divided into high and low SES groups. Latent variable structural equation modeling was used to examine the relative effects of the different types of capital on health for each SES group. The differences in the SES subgroup capital coefficients were compared across the subgroups. Results. Capital was found to work differently in the different SES groups. Financial capital generally had a greater direct protective effect on health in the low versus high SES group. Social capital had a greater direct protective effect on self-rated health in the high versus the low SES group; all social capital effects on health were indirect for the low SES group. The effects of human capital were mixed. Human capital generally had the largest protective effects on health within both groups. Conclusions. We found support for the contention that a differential distribution of social, personal, and economic resources within the social structure are fundamental causes of differentials in population health for near-old adults. If social stratification is not considered explicitly in health policy, a general improvement in population health may be achieved but not a lessening of the SES differentials in health.
Keywords: Health Conditions and Status; Healthcare; Net Worth and Assets

Cognition and Wealth: The Importance of Probabilistic Thinking - Lee A. Lillard; Robert J. Willis (Michigan Retirement Research Center at the University of Michigan, 2001)
Proposed reforms of Social Security that expand household choice and private sector trends away from defined benefit pension plans toward defined contribution plans offer new financial planning options. Although these options have many potential benefits for households, critics argue that many people will fail to make choices that exploit them, and, consequently, that expanded choice will increase the risks of poverty for some populations. Subjective probabilities are key in models of optimal financial planning, yet little is known about the capacity of individuals to use probabalistic thinking in this area. In the research reported here, we used a battery of subjective probability questions administered to more than 20,000 people in the Health and Retirement Study to investigate how probabalistic thinking affects portfolio choices and net worth. Our objectives are to develop a measure of competence in probabilistic thinking and to link this measure to risk aversion and financial outcomes.
Keywords: Health Conditions and Status; Net Worth and Assets

Depressive Symptomatology in Middle-aged and Older Married Couples: A dyadic analysis - Aloen L. Townsend; Baila Miller; Guo, S. (The Journals of Gerontology: Social Sciences, 2001)
OBJECTIVES: Depressive symptomatology has been frequently conceptualized as an individual matter, but social contextual models argue that symptom levels are likely to covary in close relationships. The present study investigated correlation between spouses' depressive symptomatology in middle-aged and older married couples, the influence of gender and race/ethnicity in predicting variability in symptom level, and the importance of individual-level covariates (education, health, and age) and couple-level covariates (household income and net worth). METHODS: Results were based on secondary analysis of Wave 1 interviews with White, Black, and Mexican American married couples (N = 5,423) from the Health and Retirement Study (HRS) and the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD). Dyadic data from husbands and wives were analyzed with multilevel modeling. RESULTS: Husbands' and wives' depressive symptoms were moderately correlated, gender and race/ethnicity (and their interaction) predicted depressive symptoms, and both individual-level and couple-level characteristics were significant covariates. Similarities as well as differences are noted between the HRS and AHEAD results. DISCUSSION: Results highlight the importance of dyadic data and multilevel models for understanding depressive symptomatology in married couples. The influence of race/ethnicity merits greater attention in future research. Differences in findings between HRS and AHEAD suggest life-course, cohort, or methodological influences.
Keywords: Adult children; Demographics; Health Conditions and Status; Methodology

Do Smokers Respond to Health Shocks? - V. Kerry Smith; Donald H. Taylor Jr.; Frank A Sloan; Desvousges, William H.; F. Reed Johnson (The Review of Economics and Statistics, 2001)
This paper reports the first effort to use data to evaluate how new information, acquired through exogenous health shocks, affects people's longevity expectations. We find that smokers react differently to health shocks than do those who quit smoking or never smoked. These differences, together with insights from qualitative research conducted along with the statistical analysis, suggest specific changes in the health warnings used to reduce smoking. Our specific focus is on how current smokers responded to health information in comparison to former smokers and nonsmokers. The three groups use significantly different updating rules to revise their assessments about longevity. The most significant finding of our study documents that smokers differ from persons who do not smoke in how information influences their personal longevity expectations. When smokers experience smoking-related health shocks, they interpret this information as reducing their chances of living to age 75 or more. Our estimated models imply smokers update their longevity expectations more dramatically than either former smokers or those who never smoked. Smokers are thus assigning a larger risk equivalent to these shocks. They do not react comparably to general health shocks, implying that specific information about smoking-related health events is most likely to cause them to update beliefs. It remains to be evaluated whether messages can be designed that focus on the link between smoking and health outcomes in ways that will have comparable effects on smokers' risk perceptions.
Keywords: Health Conditions and Status

Does Childhood Health Affect Chronic Morbidity in Later Life? - Blackwell, Debra L.; Mark D Hayward; Eileen M. Crimmins (Social Science and Medicine, 2001)
Examines whether childhood health has long-term and enduring consequences for chronic morbidity, and addresses two methodological issues of concern in the literature: (1) Is adult height a surrogate for childhood health experiences in modeling chronic disease in later life? and (2) Are the effects of adult socioeconomic status on chronic disease overestimated when childhood health is not accounted for? The analysis is based on a topical module to the third wave of the Health and Retirement Study, a representative survey of US adults, ages 55 -65, in 1996. Our results support the hypothesis that poor childhood health increases morbidity in later life. This association is found for cancer, lung disease, cardiovascular conditions, and arthritis/rheumatism. The associations were highly persistent in the face of statistical controls for both adult and childhood socioeconomic status. No support was found for using adult height as a proxy for the effects of childhood health experiences. Further, the effects of adult socioeconomic status were not overestimated when childhood health was excluded from the explanatory models. Results point to the importance of an integrated health care policy based on the premise of maximizing health over the entire life cycle. 6 Tables, 43 References. Adapted from the source document
Keywords: Adult children; Demographics; Health Conditions and Status

Duration or Disadvantage? Exploring Nativity, Ethnicity and Health in Midlife - Jacqueline L. Angel; Cynthia J. Buckley; Sakamoto, Arthur (The Journals of Gerontology: Social Sciences, 2001)
Objectives This study examined nativity as a risk factor for poor physical and emotional health for an ethnically diverse population making the transition into retirement. The authors addressed whether the health disadvantage observed for immigrants lessens with increased time spent in the country (supporting theories of assimilation) or increases with duration of residence (supporting theories of cumulative disadvantage). Methods The sample was drawn from Waves 1 and 2 of the Health and Retirement Study (HRS), an in-depth economic, social, and health database of persons in midlife and beyond. The analyses were restricted to 9,912 native-born and 1,031 foreign-born individuals. Results The data revealed that after socioeconomic factors were controlled, foreign-born individuals were at higher risk of poor emotional health than their native-born counterparts. Although aging immigrants displayed worse health than the native-born population, this disadvantage was mediated by duration of residence (young age at migration) and socioeconomic incorporation. Discussion These findings extend our understanding of nativity and duration as risk factors for poor physical and emotional health. Immigrants may overcome the nativity disadvantages found for emotional distress with increased duration of residence, but the pattern becomes more complicated with the inclusion of race and Hispanic ethnicity.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Net Worth and Assets; Women and Minorities

Eddies in the Stream: The Prevalence of Uncertain Plans for Retirement - David J Ekerdt; Kyle J Hackney; Karl Kosloski; S. DeViney (The Journals of Gerontology: Social Sciences, 2001)
OBJECTIVE: This study examined an assumption of retirement theory that typifies older workers as preretirees who are planfully engaged in paths toward retirement. METHODS: Using survey responses among workers in the 1992 and 1994 waves of the Health and Retirement Study, we described the prevalence of nonsubstantive answers to questions about the expected form and timing of retirement (e.g., don't know, haven't thought about it ). We tested explanations for this uncertainty as an artifact of the survey process, but also as an outcome of the opportunity structure for retirement planning. RESULTS: Survey procedure did generate some of these noncommittal responses. Depending on question type, approximately 10 to 40 of workers did not state when or how they would retire, and such responses were less prevalent across age and time. In addition, categorical uncertainty about form and timing was theoretically predictable in a framework that supposed that workers less subject to a socially attended life--at work or away--would be more undecided about the future. DISCUSSION: Uncertainty is an authentic, meaningful stance toward retirement that theory and research design should not ignore. Just as actual transitions to retirement can be ambiguous or blurred, the expectation of retirement, as well, can be untidy.
Keywords: Demographics; Employment and Labor Force; End of life decisions; Health Conditions and Status; Healthcare; Methodology; Other; Retirement Planning and Satisfaction; Time Use

The Effect of Health on Employment Transitions of Older Men - David M. Blau; Gilleskie, Donna B. (Worker Wellbing in a Changing Labor Market, 2001)
Keywords: Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction

Effects of Alcohol Consumption on Disability Among the Near Elderly: A Longitudinal Analysis - Ostermann, Jan; Frank A Sloan (The Milbank Quarterly, 2001)
In this study the 1992, 1994, 1996, and 1998 waves of the Health and Retirement Study were used as a way to ascertain the validity of government policy changes in transfer benefits based on alcohol consumption and disability. Are heavy drinkers more likely than abstainers or moderate drinkers to be disabled and receiving transfers from SSDI or SSI? (cross-sectional analysis). How have the 1996 policy revisions changed the amount of government transfers given to the disabled who consume alcohol and the ease in receiving such receipts? (longitudinal analysis). The authors discuss many ways in which alcohol use may effect a persons body and ability to complete tasks, as well as, some ways in which preferences toward alcohol consumption can affect ones economic and financial decisions. At wave 4 in 1998 they find there is a strong correlation between rates of disability and the drinking behavior/history of drinking problems reported in Wave 1 of 1992. However, moderate drinkers were the least likely to be disabled in 1998 and the abstainers were the most likely. At the same time though, those that reported being heavy drinkers, had the most limitations on their abilities and were the most likely to be receiving SSDI or SSI transfers. The odds of death between two years (time interval between waves) was insignificant, but those who drank heavily reported more limitations at each subsequent wave. The change in policy had practically no effect on number of people collecting SSDI/SSI. Heavy and problem drinkers were less numerous among those receiving SSDI/SSI after the policy changes, but the data in this study were unable to pinpoint the specific reasons for this outcome.
Keywords: Disabilities; Health Conditions and Status; Net Worth and Assets; Social Security

Elderly Labor Supply: Work or Play? - Steven Haider; Loughran, David (Boston College, 2001)
As the labor force has begun to retire at earlier ages and the population of the U.S. continues to age, people over the age of 65 that are still working have become a very important part of the economy. This study creates many questions that will allow the researchers to find out why some people over the age of 65 continue to work. Those elderly people that work past normal retirement age, somewhat surprisingly, are the ones that are most educated, wealthiest, and healthiest. At the same time these elder workers receive less compensation than younger workers and less compensation then they had in the past. Health was found to be the deciding factor in whether or not these elderly people stay in the workforce.
Keywords: Employment and Labor Force; Health Conditions and Status; Other; Retirement Planning and Satisfaction

Explaining the Role of Sex on Disability: A population-based study - Linda A. Wray; Caroline S Blaum (The Gerontologist, 2001)
PURPOSE: There is no clear consensus about how sex influences prevalent disability and through what mechanisms. We investigated whether sex had a direct independent effect on disability or whether sex had an interactive effect on the relationship between chronic diseases/conditions and disability, and whether these effects differed in middle-aged versus older adults. DESIGN AND METHODS: We used baseline data from two nationally representative health interview surveys, the Health and Retirement Study (HRS) and the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD), and disability and covariate measures that were nearly identical in both surveys. Logistic regression models tested the contributions of diseases, impairments, and demographic and social characteristics on difficulties with prevalent activities of daily living (ADLs), mobility, and strength. RESULTS: Models demonstrated no direct sex effect for ADL disability in either age group after adjusting for key covariates. However, sex did exert an indirect effect on ADL disability in older adults via musculoskeletal conditions and depressive symptoms. In contrast, female sex remained strongly associated with mobility and strength disability in both age groups, net of covariates. Major interactions were also significant, including a female sex/body mass index (BMI) interaction for mobility difficulty and several sex-disease interactions for strength disability in the middle-aged group. IMPLICATIONS: The effect of sex on ADL difficulty is largely explained by social and health-related covariates in middle-aged and older adults. In contrast, the independent association of female sex with decreased strength and mobility in both groups cannot be explained by our models' social or health-related variables. In addition, the positive association of BMI with mobility difficulty is significantly worse for women than for men.
Keywords: Demographics; Disabilities; Health Conditions and Status; Methodology

Giving Incentives of Adult Children Who Care for Disabled Parents - Shelley I. White-Means; Gong-Soog Hong (Journal of Consumer Affairs, 2001)
What motivates adult children in the United States to care for their disabled parents? This paper examines whether altruism and bequest motives influence adult childrens decisions about giving time to care for a disabled parent, giving financial resources, and giving future financial resources. Further, the paper examines the ways these different forms of giving affect caregivers' overall well-being, financial, family life, and life satisfaction. Using data from the 1992 Health and Retirement Study, we find that bequest incentives, noneconomicllly motivated altruism, the type of disability faced by the parent, and considerations of opportunity cost are key factors. They influence adult childrens decisions about employment, giving time, and giving money to support disabled parents. General well-being, financial and family life satisfaction are lower when adult children risk long term income resources by decreasing labor market participation. Giving money increases family life satisfaction for adult children who care for parents who have cognitive limitations. While giving time to care for disabled parents increases financial satisfaction among adult children, it decreases their family life satisfaction.
Keywords: Adult children; Demographics; Employment and Labor Force; Health Conditions and Status; Net Worth and Assets

The Health Consequences of Labor Market Segregation - Oh, Hyun Joo (Southern Sociological Society, 2001)
Despite the increased participation of people of color and women throughout all levels of work organization, racial and gender segregation of the labor market persists. These divisions can be considered a generating and perpetuating source of societal inequality, because work is a primary determinant of social and economic status. By implication, the segregation of the labor market may contribute to socioeconomic disparities in health status that have persisted over time. To investigate this hypothesis, I analyze data from the 1992 and 1994 waves of the Health and Retirement Study, which provides information about black and white women and men whose ages range from approximately 51 to 61 years at baseline (1992). The sample is limited to adults who were working in 1992 and who survived until the 1994 interview, during which they reported self-ratings of their health. The empirical results indicate that gender mix is not as important as racial composition. A lower percentage of whites is linked to worse self-reported health for both women and men. In addition, women's health reflects significant race differences in the effects of racial composition. Circumstances involving fewer whites pose health advantages for black women, whereas the health of white women suffers.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Women and Minorities

Health Insurance, Habits and Health Outcomes: A dynamic stochastic model of investment in health - Ahmed Khwaja (University of Minnesota, 2001)
I develop a dynamic stochastic model of individual choices about, health insurance, exercise, smoking, alcohol consumption and medical treatment. The objective is to estimate the parameters of the model to conduct counter-factual health policy experiments. The model is estimated using data on 3671 males from the Health and Retirement Study. The estimated model matches well the means, frequencies and transitions for all the choices and health states. The income and out of pocket medical expenditure trajectories also fit well. The estimates are used for two radically different counter-factual health policy experiments. The first experiment simulates the provision of comprehensive health insurance coverage wherein every individual is mandated to purchase an insurance plan that charges a premium of $1000.0 Per annum but covers all out of pocket costs. The simulations suggest that the proportion of individuals consuming alcohol falls slightly in the younger years (up to 0.05%) And rises (up to 0.4%) In the later years compared to the baseline simulations. Smoking rates show a small rise of up to 0.5%. The proportion of individuals seeking medical treatment increases by up to 49%. The second experiment simulates the withdrawal of subsidized medical care wherein all individuals are denied health insurance. Simulations reveal that the proportion of individuals consuming alcohol rises by up to 0.3% In the younger ages and decreases by a similar amount in the older ages. Smoking rates increase by up to 0.17% At the younger ages and fall by up to 0.6% At the older ages. The proportion of individuals seeking medical care falls by up to 95%. The two experiments together suggest that subsidized medical treatment increases the demand for medical care but does not significantly increase unhealthy behaviors. On the contrary withdrawal of subsidized medical treatment reduces demand for medical services but increases unhealthy behaviors at the younger ages. In particular, the model provides no evidence of the existence of a moral hazard problem associated with the provision of subsidized medical care on habits like smoking and alcohol consumption.
Keywords: Health Conditions and Status; Medicare/Medicaid/Health Insurance; Other

Health Risk and Portfolio Choice - Ryan D. Edwards (University of California-Berkeley, 2001)
Keywords: Consumption and Savings; Health Conditions and Status

Health, Wealth, and Gender: Do Health Shocks of Husbands and Wives Have Different Impacts on Household Wealth? - Jennifer L. Ward-Batts (The University of Michigan, Michigan Retirement Research Center, 2001)
The extent to which men s versus women s health affects household wealth and the mechanisms through which these effects occur have important implications for the welfare of older individuals living with a spouse, and in particular for women who are likely to outlive their husbands by several years. Intermediate mechanisms through which individual health shocks may affect household wealth are discussed. Four waves of HRS data on married couples are used to estimate the direct effect of onset of various health conditions on household wealth, with these effects allowed to differ for husbands and wives. Estimates using only wave 2 health shocks (controlling for baseline health) indicate that the impact of a health shock to the wife has a larger negative impact than a health shock to the husband, which is consistent with prior work. Estimates in which health shocks from waves 2-4 are allowed for produce conflicting results. Further research is required to ascertain the reason for this apparent conflict.
Keywords: Adult children; Health Conditions and Status

How Costly are Smokers to Medicare? - Frank A Sloan; Gabriel A. Picone (Private Versicherung und Soziale Sicherung: Festschrift zum 60. Geburtstag von Roland Eisen, 2001)
Keywords: Consumption and Savings; Health Conditions and Status; Medicare/Medicaid/Health Insurance

How Costly Are Smokers to Other People? Longitudinal Evidence on the Near Elderly - Gabriel A. Picone; Frank A Sloan (Frontiers in Health Policy Research, 2001)
This study looks at the impact that smoking has on people over the course of time. Data and studies on the costs of smoking, not just for the smoker but for people around them, are very important for many issues. People aged 51-67 are used since that is the time frame where health problems caused by smoking tend to be most prominent. The researchers calculate the costs from healthcare based on the type of insurer. In the end it is concluded that government payers and then Medicare and Medicaid take the largest amount of the financial problem for smoking. Private insurance companies did not seem to take on a great deal of the costs from this behavior.
Keywords: Demographics; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance

The Impact of Age, Gender, and Race on the Relationship Between Depression and Self-Rated Health in Community-Dwelling Older Adults: A longitudinal study - Beth Han (Home Health Care Services Quarterly, 2001)
Objective: To examine whether the prediction of baseline depression for subsequent changes in self-rated health is consistent across different age cohorts, gender, and racial groups. Data Sources and Study Setting: A total of 6,714 participants who were 65 years old or older and took part in both the first and the second wave of Assets and Health Dynamics among the Oldest-Old (AHEAD) national survey of community-dwelling older adults were examined. Study Design: A two-year prospective cohort study. Principle Findings: Baseline depression was an independent risk factor, which not only decreased the odds of having substantial improvement in self-rated health but also increased the possibility of having substantial decline in self-rated health in older men and women, and in Blacks and Whites of all age groups. Conclusions: Early prevention and treatment of depression among community-dwelling older adults may not only reduce their health decline but also promote their health.
Keywords: Demographics; Health Conditions and Status

The Impact of Body Weight on Physical Functioning Across the Later Years - Kristi Rahrig Jenkins (Wayne State University, 2001)
An extensive body of literature analyzes the impact of body weight and various health outcomes documenting that extremes in body weight adversely effect health. Much less is known about how body weight specifically impacts physical functioning. Some studies, however, have shown an association between having excessive body weight and heightened risk for certain diseases and functional impairment. With evidence that the population is becoming heavier in greater proportions than in the past, body weight as it contributes to physical functioning remains a critical health problem. The project addresses some of the questions central to body weight and physical functioning. For example, how do certain socioeconomic and demographic characteristics, health behaviors, and health characteristics effect the relationship between body weight and physical functioning? Is the effect of body weight specific to certain functional domains? In addition, is the basic relationship between body weight and physical functioning different in young old populations than in old old populations? Using longitudinal data from the Health and Retirement Study (sample of young old adults) and asset and health dynamics among the oldest old survey (sample of old old adults) logistic regression models on the loss of physical functioning (1 = impaired) over a two year period are estimated for the young old and old old separately. A model comparing the young old and the old old is also estimated. Results indicate that body weight, more specifically obesity, impacts physical functioning across various domains of impairment. When influencing these domains, body weight acts directly but also indirectly with other factors (socioeconomic and demographic characteristics, health behaviors, and health characteristics). In addition, important differences exist by cohort membership. The project concludes by addressing implications and areas for future research.
Keywords: Adult children; Health Conditions and Status; Healthcare; Net Worth and Assets

Impact of Displacement on Older Workers - Steven Haider (Santa Monica, CA, RAND Corp, 2001)
We examine the impact of job displacement on older workers. Whereas previous studies focus on the earnings losses associated with displacement, we examine compensation losses more generally. Using the Health and Retirement Study, we measure the impact of a job loss on earnings, pension wealth, and health insurance. When pension and health insurance losses are incorporated to measure the overall impact of a displacement, the estimated total compensation loss increases by nearly 100 percent relative to the standard analysis that only examines earnings losses.
Keywords: Employment and Labor Force; Health Conditions and Status; Income; Insurance; Other; Retirement Planning and Satisfaction

The Impact of Involuntary Job Loss on Subsequent Alcohol Consumption by Older Workers: Findings from the Health and Retirement Survey - William T Gallo; Elizabeth H Bradley; Michele J. Siegel; Stanislav V Kasl (The Journals of Gerontology: Social Sciences, 2001)
OBJECTIVE: To estimate the effect of involuntary job loss on subsequent alcohol consumption by older workers in the United States. METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, the authors estimated multivariate models to assess the impact of involuntary job loss on subsequent alcohol use. Two outcomes were investigated: reported daily alcohol consumption and onset of drinking. The analysis sample included 207 workers who experienced involuntary job loss between survey dates and a comparison group of 2,866 continuously employed workers. RESULTS: After baseline alcohol consumption and a variety of socioeconomic and illness-related covariates were controlled, involuntary job loss was not associated (p .05) with number of daily drinks consumed at follow-up. However, among those who did not consume alcohol at baseline, individuals who suffered involuntary job loss were twice as likely as continuously employed individuals to start drinking by follow-up (OR = 2.01; CI = 1.06-3.80). The majority of those who began drinking at follow-up reported drinking less than 1 drink per day. DISCUSSION: The findings provide evidence of a significant relationship between job loss and subsequent alcohol use among baseline nondrinkers. However, the magnitude of the changes in drinking was quite modest.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare; Methodology; Other; Retirement Planning and Satisfaction; Risk Taking

Improving memory among older americans - Associated Press (Associated Press, 2001)
Keywords: Health Conditions and Status

Lack of Health Insurance and Decline in Overall Health in Late Middle Age - David W. Baker; Joseph J Sudano; Jeffrey M. Albert; Elaine A Borawski; Avi Dor (New England Journal of Medicine, 2001)
BACKGROUND: The number of adults in their 50s and 60s in the United States who do not have health insurance is increasing. This group may be particularly vulnerable to the ill effects of being uninsured. METHODS: We conducted a prospective cohort study using files from the Health and Retirement Study, a national survey of adults who were 51 to 61 years old in 1992. We determined the risks of a major decline in overall health and of the development of new physical difficulties between 1992 and 1996 for participants who were continuously uninsured (uninsured in 1992 and in 1994), those who were intermittently uninsured (uninsured either in 1992 or in 1994), and those who were continuously insured. We used logistic regression to determine the independent effects of being uninsured on health outcomes after adjustment for base-line sociodemographic factors, preexisting medical conditions, and types of health-related behavior such as smoking and alcohol use. RESULTS: We analyzed data for 7577 participants. The 717 continuously uninsured participants and the 825 intermittently uninsured participants were more likely than the 6035 continuously insured participants to have a major decline in overall health between 1992 and 1996 (21.6 percent, 16.1 percent, and 8.3 percent of the three groups, respectively; P 0.001 for both comparisons). According to a multivariate analysis, the adjusted relative risk of a major decline in overall health was 1.63 (95 percent confidence interval, 1.26 to 2.08) for continuously uninsured participants and 1.41 (95 percent confidence interval, 1.11 to 1.78) for intermittently uninsured participants, as compared with continuously insured participants. A new difficulty in walking or climbing stairs was also more likely to develop in the continuously or intermittently uninsured participants than in the continuously insured participants (28.8 percent, 26.4 percent, and 17.1 percent of the three groups, respectively; P 0.001 for both comparisons). The adjusted relative risk of such a new physical difficulty was 1.23 (95 percent confidence interval, 1.02 to 1.47) for the continuously uninsured participants and 1.26 (95 percent confidence interval, 1.01 to 1.54) for the intermittently uninsured participants. CONCLUSIONS: The lack of health insurance is associated with an increased risk of a decline in overall health among adults 51 to 61 years old.
Keywords: Demographics; Health Conditions and Status; Medicare/Medicaid/Health Insurance; Methodology; Other

Longevity Expectations and Death: Can People Predict Their Own Demise? - V. Kerry Smith; Frank A Sloan; Donald H. Taylor Jr. (The American Economic Review, 2001)
Keywords: Expectations; Health Conditions and Status

Longevity-Insured Retirement Distributions from Pension Plans: Market and Regulatory Issues - Brown, Jeffrey R.; Mark J. Warshawsky (NBER Working Paper, 2001)
Increasing average longevity and the trend toward early retirement make the risk of outliving one's resources more widespread among the elderly population. Annuities insure individuals against financial risks associated with longevity uncertainty. This paper explores the extent to which retirees can and do insure themselves against longevity risk in private pension plans. The shift from defined benefit (DB) plans to defined contribution (DC) plans means a reduction in the opportunities available to retirees to annuitize retirement assets because only a small number of DC plans include life annuity as a payout option. The paper discusses some of the options available to policy makers interested in increasing the annuitization rates.
Keywords: Demographics; Health Conditions and Status; Insurance

Nativity and Self-Assessed Health Among Pre-Retirement Age Hispanics and Non-HispanicWhites - Jacqueline L. Angel; Cynthia J. Buckley; Finch, Brian K. (International Migration Review, 2001)
Economic, social and familial resources are known to influence subjective health assessments. We examine the salience of nativity in determining how these resources influence self-assessed health using a large, nationwide sample of Hispanic and non-Hispanic white adults. The results indicate that while education, accumulated assets and marital status benefit the physical and emotional health of the native and foreign-born, family resources and income are significant only for the native-born. English language proficiency is a significant protective factor for both groups and is especially protective for immigrants. These surprising findings call into question previous studies stressing the positive role of the family in maintaining immigrant health.
Keywords: Demographics; Health Conditions and Status; Women and Minorities

Predictors of Mortality among the Elderly - Michael D Hurd; Daniel McFadden; Merrill, Angela (Themes in the Economics of Aging, 2001)
This paper examines the quantitative importance of some predictors of mortality among the population aged 70 and over. As expected, this research confirms that socioeconomic status is related to mortality. This relationship is strong at younger ages and appears to weaken as the cohort gets older. The 13 health indicators are also strong predictors of mortality. Results also show that subjective probabilities of survival predict mortality and remain strong predictors even after controlling for socioeconomic indicators and health conditions.
Keywords: Demographics; Expectations; Health Conditions and Status; Net Worth and Assets

Products Of Clean Living - Williams, Marjorie (Washington Post, 2001)
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction

Race Differences in Cognitive Functioning Among Older Adults - Zsembik, Barbara A.; M. Kristen Peek (The Journals of Gerontology: Social Sciences, 2001)
Objectives. Explaining race differences in cognitive functioning in later life continues to challenge researchers. This study was an attempt to incorporate the clinical literature, emphasizing biological correlates of cognitive functioning, and the social research literature, emphasizing social inequalities and consequent health outcomes, in the examination of sources of race differences in cognitive functioning in older adults. Methods. With data from Wave 1 of the Assets and Health Dynamics of the Oldest Old survey, the authors used structural equation models (LISREL 8.30) to estimate the direct effects of race on cognitive functioning and indirect effects through social and biological risk factors for the total sample (N = 5,955). Results. Race had a direct association with cognitive functioning. Race also had indirect effects on cognitive functioning through social risk factors-education and health insurance. There did not appear to be indirect effects of race through biological risk factors. Discussion. The direct and indirect effects of race through social risk factors attest to the importance of examining different ways through which race can influence cognitive functioning of older adults. This research also emphasizes the need for researchers to investigate more closely race differences in dimensions of cognitive functioning and cognitive functioning over time.
Keywords: Demographics; Health Conditions and Status

Racial, Ethnic, and Sociodemographic Differences in the level of Psychosocial Distress Among Older Americans - Mills, Terry L.; John C Henretta (Research on Aging, 2001)
This paper explores the reasons for the observed differences in the level of self-reported depressive symptoms between older African Americans, Hispanic-English speaking, Hispanic-Spanish speaking, and Whites. For all groups in the sample, being male, married, having a high level of education, and good health are strong indicators of lower levels of depressive symptoms. Comparing the levels of self-reported depressive symptoms among the different racial/ethnic groups demonstrated that there are large differences, with the Hispanic-Spanish speaking individuals reporting the highest scores. Results show that language acculturation, the number of years of education, and the number of years of U.S. residency are significant factors that help to explain these differences.
Keywords: Demographics; Health Conditions and Status; Net Worth and Assets; Women and Minorities

Retirement Incentives and Expectations - Sewin Chan; Ann H. Stevens (NBER Working Paper, 2001)
This paper investigates the relationship between expectations concerning retirement and incentives for retirement provided by employer-sponsored pension plans and Social Security. Measures of pension wealth and broader measures including earnings, Social Security, and assets are significantly related to individuals' expectations to continue work in their 60s. Results show that individuals strongly consider these incentives when planning for retirement. However, the degree to which these incentives affect behavior varies greatly between OLS and fixed-effects estimation strategies.
Keywords: Employment and Labor Force; Expectations; Health Conditions and Status; Net Worth and Assets; Retirement Planning and Satisfaction