Social Investment Policies and Childbearing Across 20 Countries: Longitudinal and Micro-Level Analyses.

This study analyses the influence of family policies on women's first and second births in 20 countries over the period 1995 to 2007. Welfare states have shifted towards social investment policies, yet family policy-fertility research has not explicitly considered this development. We distinguish between social investment-oriented and passive support that families may receive upon the birth of a child and consider changes in policies over time. These indicators are merged with fertility histories provided by harmonized individual-level data, and we use time-conditioned, fixed effects linear probability models. We find higher social investment-oriented support to be correlated with increased first birth probabilities, in contrast to passive family support. First birth probabilities particularly declined with higher passive family support for women over age 30, which points to a potential increase in childlessness. Social investment-oriented support is positively related to first and second births particularly for lower-educated women and has no relationship to childbirth for highly educated women, countering the Matthew-effect assumptions about social investment policies. Passive support is negatively related to second births for post-secondary educated women and those who are studying. Family policies that support women's employment and labour market attachment are positively linked to family expansion and these policies minimize educational differences in childbearing.

COVID-19 mortality across occupations and secondary risks for elderly individuals in the household: A population register-based study.

OBJECTIVES: This is the first population-level study to examine inequalities in COVID-19 mortality according to working-age individuals' occupations and the indirect occupational effects on COVID-19 mortality of older individuals who live with them. METHODS: We used early-release data for the entire population of Sweden of all recorded COVID-19 deaths from 12 March 2020 to 23 February 2021, which we linked to administrative registers and occupational measures. Cox proportional hazard models assessed relative risks of COVID-19 mortality for the working-aged population registered in an occupation in December 2018 and the older population who lived with them. RESULTS: Among working aged-adults, taxi/bus drivers had the highest relative risk of COVID-19 mortality: over four times that of skilled workers in IT, economics, or administration when adjusted only for basic demographic characteristics. After adjusting for socioeconomic factors (education, income and country of birth), there are no occupational groups with clearly elevated (statistically significant) COVID-19 mortality. Neither a measure of exposure within occupations nor the share that generally can work from home were related to working-aged adults' risk of COVID-19 mortality. Instead of occupational factors, traditional socioeconomic risk factors best explained variation in COVID-19 mortality. Elderly individuals, however, faced higher COVID-19 mortality risk both when living with a delivery or postal worker or worker(s) in occupations that generally work from home less, even when their socioeconomic factors are taken into account. CONCLUSIONS: Inequalities in COVID-19 mortality of working-aged adults were mostly based on traditional risk factors and not on occupational divisions or characteristics in Sweden. However, older individuals living with those who likely cannot work from home or work in delivery or postal services were a vulnerable group.

Building an interdisciplinary framework to advance conceptual and technical aspects of population-environment research focused on women's and children's health.

Great gains have been made in providing researchers geo-spatial data that can be combined with population health data. This development is crucial given concerns over the human health outcomes associated with a changing climate. Merging population and environmental data remains both conceptually and technically challenging because of a large range of temporal and spatial scales. Here we propose a framework that addresses and advances both conceptual and technical aspects of population-environment research. This framework can be useful for considering how any time or space-based environmental occurrence influences population health outcomes and can be used to guide different data aggregation strategies. The primary consideration discussed here is how to properly model the space and time effects of environmental context on individual-level health outcomes, specifically maternal, child and reproductive health outcomes. The influx of geospatial health data and highly detailed environmental data, often at daily scales, provide an opportunity for population-environment researchers to move towards a more theoretically and analytically sound approach for studying environment and health linkages.

Sick leave absence and the relationship between intra-generational social mobility and mortality: health selection in Sweden.

BACKGROUND: Poor health could influence how individuals are sorted into occupational classes. Health selection has therefore been considered a potential modifier to the mortality class gradient through differences in social mobility. Direct health selection in particular may operate in the short-term as poor health may lead to reduced work hours or achievement, downward social mobility, unemployment or restricted upward mobility, and death. In this study, the relationship between social mobility and mortality (all-cause, cancer-related, cardiovascular disease-related (CVD), and suicide) is explored when the relationship is adjusted for poor health. METHODS: Using Swedish register data (1996-2012) and discrete time event-history analysis, odds ratios and average marginal effects (AME) of social mobility and unemployment on mortality are observed before and after accounting for sickness absence in the previous year. RESULTS: After adjusting for sickness absence, all-cause mortality remained lower for men after upward mobility in comparison to not being mobile (OR 0.82, AME -0.0003, CI - 0.0003 to - 0.0002). Similarly, upward mobility continued to be associated with lower cancer-related mortality for men (OR 0.85, AME -0.00008, CI - 0.00002 to - 0.0002), CVD-related mortality for men (OR 0.76, AME -0.0001, CI - 0.00006 to - 0.0002) and suicide for women (OR 0.67, AME -0.00002, CI - 0.000002 to - 0.00003). The relationship between unemployment and mortality also persisted across most causes of death for both men and women after controlling for previous sickness absence. In contrast, adjusting for sickness absence renders the relationship between downward mobility and cancer-related mortality not statistically different from the non-mobile. CONCLUSIONS: Health selection plays a role in how downward mobility is linked to cancer related deaths. It additionally accounts for a portion of why upward mobility is associated with lower mortality. That health selection plays a role in how social mobility and mortality are related may be unexpected in a context with strong job protection. Job protection does not, however, equalize opportunities for upward mobility, which may be limited for those who have been ill. Because intra-generational upward mobility and mortality remained related after adjusting for sickness absence, other important mechanisms such as indirect selection or social causation should be explored.

Conflict and Contraception in Colombia.

This study explores how armed conflict relates to contraceptive use in Colombia, combining data from the Uppsala Conflict Data Program and Demographic and Health Surveys 1990-2016. Our study is the first systematic effort to investigate whether and how violent conflict influences women's contraceptive use, using nationally representative data across all stages of women's reproductive careers. With fixed effects linear probability models, we adjust for location-specific cultural, social, and economic differences. The results show that although modern contraceptive use increased over time, it declined according to conflict intensity across location and time. We find no evidence that this relationship varied across socioeconomic groups. Increased fertility demand appears to explain a small portion of this relationship, potentially reflecting uncertainty about losing a partner, but conflict may also result in lack of access to contraceptive goods and services.

Intragenerational social mobility and cause-specific premature mortality.

This study explores whether there is a short-term relationship between intragenerational social mobility and mortality while individuals are working and whether it is widespread across different causes of death. Net of accumulated advantages and disadvantages, social mobility may influence mortality through health selection or changes in well-being. Men and women working in 1996 up to age 65 are observed annually until 2012 in Swedish register data. Time-varying covariates and origin and destination status are controlled for in discrete time event-history analyses. Results show that when men were upwardly mobile, mortality was lower due to cancer, CVD, IHD, and suicide. Upward mobility was only associated with lower odds of suicide for women. When downwardly mobile, cancer mortality was higher for both men and women and smoking-related cancer mortality was higher for men. Social mobility was not linked to deaths related to accidents and poisoning or alcohol-related mortality. The results may support a relationship between social mobility and mortality characterized by health selection: Only in the case of a chronic illness (cancer) was downward mobility associated with higher mortality. The widespread relationship between upward mobility and lower mortality for men may also indicate positive health selection into attaining a higher class and that individuals with poor health may be less likely to search for better positions or receive promotions.

Unemployment, intragenerational social mobility and mortality in Finland: heterogeneity by age and economic context.

BACKGROUND: We explore how mortality is related to unemployment and intragenerational social mobility in Finland. Unemployment and social mobility are two labour market experiences that are largely studied separately, despite the fact that selection processes into unemployment and downward mobility are intertwined. Because both causal and health selection mechanisms may vary depending on the timing of these experiences, we consider heterogeneity by age and economic context. METHODS: We run discrete time event history analysis for death (at age 30-75 years) in two periods (economic recession and growth) and analyse younger and older individuals and men and women separately. RESULTS: The odds of mortality were particularly high for individuals experiencing unemployment and when unemployment occurred during economic growth (OR ranging between 1.39 and 2.77). Younger men had high odds of mortality following unemployment (OR 1.86-2.77). In contrast, downward mobility was associated with higher odds of mortality only among older men and women and only during economic growth. The benefits of upward mobility were experienced mainly by younger men (OR ranging between 0.86 and 0.87) and were not experienced by women at all. CONCLUSION: Results show that when in an individual's life and the economic cycle unemployment and social mobility occur matters for whether these experiences are associated with mortality.

An application of diagonal reference models and time-varying covariates in social mobility research on mortality and fertility.

In social mobility research, the diagonal reference model (DRM) is argued to best isolate the effect of social mobility from origin and destination status effects. In demographic research, standard analyses of the duration until an event occurs rely heavily on the appropriate use of covariates that change over time. We apply these best-practice methods to the study of social mobility and demographic outcomes in Sweden using register data that covers the years 1996-2012. The mortality analysis includes 1,024,142 women and 747,532 men and the fertility analysis includes 191,142 women and 164,368 men. We identify the challenges inherent in this combination and present strategies with an application to how social mobility is related to both fertility and mortality. Our application is successful at incorporating all requirements related to these methods. Our findings suggest, however, that certain data characteristics, such as a relatively high share of missing data, can be problematic. We also find that controlling for origin and destination status generally provides acceptable estimates of the mobility association in the specific case of Sweden and the relationship between social mobility and both fertility and mortality.

Men's health and co-residence with older generations in Russia: better or worse?

BACKGROUND: Previous studies show contradictory findings on the relationship between health and intergenerational living arrangements (ILAs), which may be due to variation in who selects themselves into and out of ILA. Addressing the selectivity into ILA and the health of the older generation, we assess whether there is a health-protective or health-damaging effect of ILA. We locate our study in the Russian context, where ILA is prevalent and men's health has become a public health issue. METHODS: We apply a fixed-effects logistic regression to self-rated health status of 11 546 men aged 25 years or older who participated in at least two waves in the Russian Longitudinal Monitoring Survey from 1994 to 2015. To further isolate the health effect of ILA, we observe only associations after transitioning into or out of ILA. RESULTS: A transition into co-residence with an unhealthy older generation increases men's odds of reporting poor health (OR=0.64, CI 0.44 to 0.93). A transition out of co-residence with a healthy older generation decreases men's odds of reporting fine health by 63% (OR=0.37, CI 0.28 to 0.50), whereas continuing to live with an unhealthy older generation decreases the odds by half (OR=0.49, CI 0.38 to 0.63). CONCLUSIONS: We reveal a health interlinkage between co-residing generations by finding a detrimental health effect of co-residence with an unhealthy older generation. No longer living with an older generation who was in fine health also negatively affects men's health. Future studies should address heterogeneity related to the health of older generations, unobserved time-constant characteristics of younger generations and selectivity into/out of ILA.

Intragenerational mobility and mortality in Russia: short and longer-term effects.

This study uses the Russian Longitudinal Monitoring Survey to explore the relationship between mortality of men age 65 or younger and intragenerational mobility, measured objectively through household income and subjectively through social ranking. This relationship is considered in light of the social selection and social causation mechanisms developed in the literature as well as a proposed mechanism in which mobility itself is a consequential life event. The analysis spans the years 1994-2010, which covers the transitional period in Russia characterized by labor market restructuring and economic crisis as well as a later period of economic growth and recovery. Using Cox proportional hazard models, immediate and longer-term associations between mobility and mortality are estimated. Both subjective and objective downward mobility had an immediate positive association with mortality risk (increased by 44% and 24%, respectively). In contrast, upward mobility had a more pronounced effect over a longer-term horizon and lowered mortality risk by 17%. Controlling for destination status attenuated some associations, but findings were robust to the adjustment of selection-related factors such as alcohol consumption and health status in the year preceding mobility. Findings suggest that the negative relationship between upward mobility and mortality may be driven by social causation, whereas downward mobility may have an independent effect beyond selection or causation.

The Post-Communist Fertility Puzzle.

Fertility has unanimously declined across the entire post-communist region. This study explores the variation in fertility trends over time among these countries and assesses to what degree three explanations are applicable: second demographic transition (SDT), postponement transition (PPT) or reaction to the economic crisis. Moreover, on the basis of SDT and PPT theoretical tenets, as well as descriptive evidence, the economic context is hypothesized to be linked to two processes of fertility decline conversely. The results show that no one theoretical explanation is sufficient to explain the complex fertility declines across the entire post-communist region from 1990 to 2003. In some countries, a great part of the decline in fertility occurred before significant postponement of childbearing began, which indicates that the dramatic decline was due to stopping behavior or postponement of higher order births. Postponement of first births, either through PPT or SDT processes, greatly contributed to fertility decline in a small number of countries. Pooled cross-sectional time-series analyses of age-specific birthrates confirm that these two distinct processes are present and show that the economic crisis explanation has explanatory power for declining birth rates. In contrast, logistic regressions show that the likelihood of postponing childbirth increases with improved economic conditions. These results confirm the importance of taking the economic context into account when discussing explanations for fertility decline. More specifically, the results indicate that the severity and duration of economic crisis, or absence thereof, influenced the extent and manner in which fertility declined.