Workshop summary: National Institutes of Health (NIH) 2022 scientific workshop on gender and health.

In this manuscript, we summarize the goals, content, and impact of the Gender and Health: Impacts of Structural Sexism, Gender Norms, Relational Power Dynamics, and Gender Inequities workshop held by the National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) in collaboration with 10 NIH Institutes, Centers, and Offices. Specifically, we outline the key points emerging from the workshop presentations, which are the focus of the collection of articles in this supplement. The overarching goals of the workshop were to convene NIH staff, the external scientific community, and the public to discuss methods, measurement, modifiable factors, interventions, and best practices in health research on gender as a social and cultural variable and to identify opportunities to advance research and foster collaborations on these key topics. Themes emerging from the workshop include the need for intersectional measures in research on gender and health, the role of multilevel interventions and analyses, and the importance of considering gender as a social and structural determinant of health. Careful, nuanced, and rigorous integration of gender in health research can contribute to knowledge about and interventions to change the social and structural forces that lead to disparate health outcomes and perpetuate inequities.

Linked Lives and Cumulative Inequality: A Multigenerational Family Life Course Framework.

Growing social and economic inequalities in the United States have been accompanied by shifts in family structure. Social and demographic changes may make multigenerational family ties (e.g., between grandparents, parents, and children) an even more important contributor than ever in perpetuating inequality. The family life course framework, which considers how dimensions of individual (age), sociohistorical (period, cohort), and processual (generation) time intersect, provides a useful structure for thinking about how multigenerational families matter for inequality today. We integrate these dimensions of time with the ideas of linked lives and cumulative inequality to propose ways in which advantage and disadvantage are transmitted and grow across multiple generations. In particular, we propose an integrative model of linked lives and cumulative inequality that extends the family life course framework into a multigenerational perspective. We conclude by identifying data sources and methodologies useful for family scholars interested in pursuing a multigenerational family approach to inequality.

Does Black Socioeconomic Mobility Explain Recent Progress Toward Black-White Residential Integration?

Studies of racial residential segregation have found that black-white segregation in U.S. metropolitan areas has declined slowly but steadily since the early 1970s. As of this writing, black-white residential segregation in the United States is approximately 25 % lower than it was in 1970. To identify the sources of this decline, we used individual-level, geocoded data from the Panel Study of Income Dynamics (PSID) to compare the residential attainment of different cohorts of blacks. We analyzed these data using Blinder-Oaxaca regression decomposition techniques that partition the decline in residential segregation among cohorts into the decline resulting from (1) changes in the social and economic characteristics of blacks and (2) changes in the association between blacks' social and economic characteristics and the level of residential segregation they experience. Our findings show that black cohorts entering adulthood prior to the civil rights movement of the 1960s experienced consistently high levels of residential segregation at middle age, but that cohorts transitioning to adulthood during and after this period of racial progress experienced significantly lower levels of residential segregation. We find that the decline in black-white residential segregation for these later cohorts reflects both their greater social and economic attainment and a strengthening of the association between socioeconomic characteristics and residential segregation. Educational gains for the post-civil rights era cohorts and improved access to integrated neighborhoods for high school graduates and college attendees in these later cohorts were the principal source of improved residential integration over this period.

Neighborhood social stressors, fine particulate matter air pollution, and cognitive function among older U.S. adults.

A growing number of studies have found a link between outdoor air pollution and cognitive function among older adults. Psychosocial stress is considered an important factor determining differential susceptibility to environmental hazards and older adults living in stressful neighborhoods may be particularly vulnerable to the adverse health effects of exposure to hazards such as air pollution. The objective of this study is to determine if neighborhood social stress amplifies the association between fine particulate matter air pollution (PM2.5) and poor cognitive function in older, community-dwelling adults. We use data on 779 U.S. adults ages 55 and older from the 2001/2002 wave of the Americans' Changing Lives study. We determined annual average PM2.5 concentration in 2001 in the area of residence by linking respondents with EPA air monitoring data using census tract identifiers. Cognitive function was measured using the number of errors on the Short Portable Mental Status Questionnaire (SPMSQ). Exposure to neighborhood social stressors was measured using perceptions of disorder and decay and included subjective evaluations of neighborhood upkeep and the presence of deteriorating/abandoned buildings, trash, and empty lots. We used negative binomial regression to examine the interaction of neighborhood perceived stress and PM2.5 on the count of errors on the cognitive function assessment. We found that the association between PM2.5 and cognitive errors was stronger among older adults living in high stress neighborhoods. These findings support recent theoretical developments in environmental health and health disparities research emphasizing the synergistic effects of neighborhood social stressors and environmental hazards on residents' health. Those living in socioeconomically disadvantaged neighborhoods, where social stressors and environmental hazards are more common, may be particularly susceptible to adverse health effects of social and physical environmental exposures.

Your Face is Your Fortune: Does Adolescent Attractiveness Predict Intimate Relationships Later in Life?

OBJECTIVE: A growing literature documents the importance of physical attractiveness in young and middle adulthood for romantic, marital, and sexual relationships, but little is known about how attractiveness in adolescence matters to intimate relationships in later life. We ask: does attractiveness early in life convey ongoing benefits late in life, or do such benefits erode over time? METHODS: We use multivariate regression models and more than 50 years of data from the Wisconsin Longitudinal Study to examine the connections between adolescent physical attractiveness and intimate relationships (i.e., sexual activity and access to potential sexual partners) in later life. RESULTS: We find that adolescent attractiveness facilitates sexual activity in later life. This relationship is largely driven by attractiveness increasing the probability of having access to potential sexual partners. However, attractiveness is not related to sexual activity among married couples, even after controlling for marital duration. Men, those in good health, and wealthier individuals are also more likely to engage in several facets of intimate relationships. DISCUSSION: These findings highlight the importance of relationship context for later life sexual activity and begin to explicate the pathways through which factors across the life course-particularly attractiveness-influence sexual activity in later life.

Psychological and cognitive determinants of mortality: Evidence from a nationally representative sample followed over thirty-five years.

Growing evidence suggests that psychological factors, such as conscientiousness and anger, as well as cognitive ability are related to mortality. Less is known about 1) the relative importance of each of these factors in predicting mortality, 2) through what social, economic, and behavioral mechanisms these factors influence mortality, and 3) how these processes unfold over long periods of time in nationally-representative samples. We use 35 years (1972-2007) of data from men (ages 20-40) in the Panel Study of Income Dynamics (PSID), a nationally representative sample in the United States, and discrete time event history analysis (n = 27,373 person-years) to examine the importance of measures of follow-through (a dimension of conscientiousness), anger, and cognitive ability in predicting mortality. We also assess the extent to which income, marriage, and smoking explain the relationship between psychological and cognitive factors with mortality. We find that while follow-through, anger, and cognitive ability are all associated with subsequent mortality when modeled separately, when they are modeled together and baseline demographic characteristics are controlled, only anger remains associated with mortality: being in the top quartile for anger is associated with a 1.57 fold increase in the risk of dying at follow-up compared with those in the bottom quartile. This relationship is robust to the inclusion of income, marriage, and smoking as mediators.

In Sickness and in Health? Physical Illness as a Risk Factor for Marital Dissolution in Later Life.

The health consequences of marital dissolution are well known, but little work has examined the impact of health on the risk of marital dissolution. We use a sample of 2,701 marriages from the Health and Retirement Study to examine the role of serious physical illness onset in subsequent marital dissolution via either divorce or widowhood. We use a series of discrete time event history models with competing risks to estimate the impact of husband's and wife's physical illness onset on risk of divorce and widowhood. We find that only measures of wife's illness onset are associated with elevated risk of divorce, while measures of either spouse's illness onset is associated with elevated risk of widowhood. Further, in the case of heart problems, we find that this gender difference is statistically significant. These findings suggest health as a determinant of marital dissolution in later life via both biological and gendered social pathways.

In sickness and in health? Physical illness as a risk factor for marital dissolution in later life.

The health consequences of marital dissolution are well known, but little work has examined the impact of health on the risk of marital dissolution. In this study we use a sample of 2,701 marriages from the Health and Retirement Study (1992-2010) to examine the role of serious physical illness onset (i.e., cancer, heart problems, lung disease, and/or stroke) in subsequent marital dissolution due to either divorce or widowhood. We use a series of discrete-time event history models with competing risks to estimate the impact of husband's and wife's physical illness onset on risk of divorce and widowhood. We find that only wife's illness onset is associated with elevated risk of divorce, while either husband's or wife's illness onset is associated with elevated risk of widowhood. These findings suggest the importance of health as a determinant of marital dissolution in later life via both biological and gendered social pathways.

Gender, job authority, and depression.

Using the 1957-2004 data from the Wisconsin Longitudinal Study, we explore the effect of job authority in 1993 (at age 54) on the change in depressive symptoms between 1993 and 2004 (age 65) among white men and women. Within-gender comparisons indicate that women with job authority (defined as control over others' work) exhibit more depressive symptoms than women without job authority, whereas men in authority positions are overall less depressed than men without job authority. Between-gender comparisons reveal that although women have higher depression than men, women's disadvantage in depression is significantly greater among individuals with job authority than without job authority. We argue that macro- and meso-processes of gender stratification create a workplace in which exercising job authority exposes women to interpersonal stressors that undermine health benefits of job authority. Our study highlights how the cultural meanings of masculinities and femininities attenuate or amplify health-promoting resources of socioeconomic advantage.

"Feeling poor": perceived economic position and environmental mastery among older Americans.

OBJECTIVE: This study examines the relationship between perceived economic position (PEP), objective socioeconomic status, and environmental mastery among older Americans. METHOD: Using data from the National Social Life, Health, and Aging Project (NSHAP), I examine (a) whether PEP is associated with environmental mastery even after accounting for objective economic status and (b) whether the relationship between PEP and mastery varies by reference group (peers, Americans). RESULTS: High PEP is associated with higher mastery while low PEP is associated with lower mastery, even after controlling for objective economic status. In general, the relationship between PEP and mastery does not vary whether PEP relative to peers or PEP relative to American families is examined. DISCUSSION: These analyses provide insights into the important role of social comparisons in the connection between socioeconomic status and psychological well-being in the later life course.

The social patterns of a biological risk factor for disease: race, gender, socioeconomic position, and C-reactive protein.

OBJECTIVE: Understand the links between race and C-reactive protein (CRP), with special attention to gender differences and the role of class and behavioral risk factors as mediators. METHOD: This study utilizes the National Social Life, Health, and Aging Project data, a nationally representative study of older Americans aged 57-85 to explore two research questions. First, what is the relative strength of socioeconomic versus behavioral risk factors in explaining race differences in CRP levels? Second, what role does gender play in understanding race differences? Does the relative role of socioeconomic and behavioral risk factors in explaining race differences vary when examining men and women separately? RESULTS: When examining men and women separately, socioeconomic and behavioral risk factor mediators vary in their importance. Indeed, racial differences in CRP among men aged 57-74 are little changed after adjusting for both socioeconomic and behavioral risk factors with levels 35% higher for black men as compared to white men. For women aged 57-74, however, behavioral risk factors explain 30% of the relationship between race and CRP. DISCUSSION: The limited explanatory power of socioeconomic position and, particularly, behavioral risk factors, in elucidating the relationship between race and CRP among men, signals the need for research to examine additional mediators, including more direct measures of stress and discrimination.

Sexual frequency decline from midlife to later life.

OBJECTIVE: To examine sexual frequency decline among American men and women between the ages of 44 and 72 born from 1933 to 1948. METHOD: Using data from the National Health and Social Life Survey (NHSLS) and the National Social Life, Health, and Aging Project (NSHAP), the decline in sexual frequency is decomposed into declines due to changes in marital status, physical health, and happiness. We examine the contribution of both changes in the composition of the population with respect to these factors as well as changes in the association between these factors and sexual frequency by age. RESULTS: For women, change in the proportion widowed is a significant factor in sexual frequency decline, as is change in the association between happiness and sexual frequency. Among men, both poorer physical health at older ages and a decrease in its association with frequency are significant factors in the decline. A change in the association between happiness and frequency is also a significant factor for men. Reverse causality may explain the happiness-frequency findings for both men and women. DISCUSSION: Results provide evidence for gendered experiences in the sexual life course.

Quality of life and psychological health indicators in the national social life, health, and aging project.

BACKGROUND: The National Social Life, Health, and Aging Project (NSHAP) measures seven indicators of quality of life (QoL) and psychological health. The measures used for happiness, self-esteem, depression, and loneliness are well established in the literature. Conversely, measures of anxiety, stress, and self-reported emotional health were modified for their use in this unique project. The purpose of this paper is to provide (a) an overview of NSHAP's QoL assessment and (b) evidence for the adequacy of the modified measures. METHODS: First, we examined the psychometric properties of the modified measures. Second, the established QoL measures were used to examine the concurrent validity of the modified measures. Finally, gender- and age-group differences were examined for each modified measure. RESULTS: The anxiety index exhibited good internal reliability and concurrent validity. Consistent with the literature, a single-factor structure best fit the data. Stress was satisfactory in terms of concurrent validity but with only fair internal consistency. Self-reported emotional health exhibited good concurrent validity and moderate external validity. CONCLUSIONS: The modified indices used in NSHAP tended to exhibit good internal reliability and concurrent validity. These measures can confidently be used in the exploration of QoL and psychological health in later life and its many correlates.

Sexual functioning in older adults.

This article reviews recent medical and social science literature on sexual functioning in older adults. We provide a broad definition of sexual functioning that includes a range of solo and partnered forms of sexual expression. We identify four determinants of sexual functioning: biologic, psychological, social context (including culture), and interactions of these with each other. Recent literature on the impact of aging and physical health documents some decline in frequency of sexual activity. Interest continues in the role of hormones in male and female sexual functioning. Recent research highlights the role of the social context, especially the presence of a sexual partner and the relationship with that partner, in sexual activity. We discuss variations in sexual functioning by life course events, gender, and race and ethnicity. Relevant results from the Global Study of Sexual Attitudes and Behaviors; Male Attitudes Regarding Sexual Health Survey; and the National Social Life, Health and Aging Project are also reviewed.