Theme 1

Partnership and parenting histories and later life health and well-being

Hypothesised mechanisms whereby partnership and parenthood are associated with later life health and mortality are closely related. In addition to common selection effects, they include effects such as accumulated stress (from past divorce or intensive childrearing for example) and accumulated effects of social control of health behaviours and social interactions related to family life. Apart from these life course accumulations of positive and negative influences, current access to support from a spouse and adult children, and associated social control of health behaviours, may influence health (both physical and mental) and mortality. Specific questions addressed included:

a) Do country level factors moderate associations between early fertility and later life health; the extent of accumulated stress associated with parenthood and the effects of disrupted partnership histories?

We examined differences between countries, separately for men and women, in associations between marital and fertility histories and later life health. This enabled us to test the hypothesis that in countries where provision of support for parents is greater, accumulated stresses of childbearing and rearing may be less. Additionally, we examined whether the – apparently adverse effects of early parenthood vary according to how usual early parenthood is.

This was undertaken using data from the Generations & Gender Surveys (GGS) and the Surveys of Ageing, Health and Retirement in Europe (SHARE). Both include retrospective information on parenthood and partnership histories and on childhood circumstances, allowing some control for antecedent influences on both adult family life courses and health outcomes.

b) Is the accumulated stress model of links between family building patterns and later health supported by evidence of worse health outcomes in certain groups exposed to particular stresses?

We used Norwegian and Swedish register data to address these questions as the larger sample size and availability of prospectively collected information made it more suitable for this purpose than the other sources. Outcome measures were mortality after age 50 analysed using discrete time hazards models and an index of morbidity derived from prescribed medication use. Fixed effect modelling and sibling comparisons were used to try and further address the problem of selection. Further collaborative work was undertaken using the UK NCDS which includes biomarker data.

Short birth intervals

Successive pregnancies may be health challenging for mothers and raising two children close in age challenging for both mothers and fathers. Some previous research has also indicated adverse effects of very long inter birth intervals. We used Norwegian register data to examine the impact of interbirth intervals on both mortality and use of prescription medication. In further work in progress (with Sanna Read and Heini Vaisenen) we are using data from ELSA to examine how fertility tempo and quantum, including experience of short birth intervals, are related to antecedent factors, such as childhood disadvantage, and later life health and the pathways linking these associations

c) How does family status and change influence health related behaviours?

Marriage and parenthood are hypothesised to be associated with greater social control of unhealthy behaviours. Both may also influence use of health care, including preventive services, as spouses may monitor each other’s health and encourage treatment seeking and mothers’ contacts with healthcare services in connection with children may have a long-term effect on their own health care use. Given recent advances in the efficacy of preventive and therapeutic interventions for conditions such as heart disease and cancer, these effects are potentially more important than in the past. We examined impacts of partnership and partnership history on health-related behaviours using data from the UK NCDS and Norwegian register data on use of prescription medication.