Doctor talks to mixed race mother and child.

Family-Centered Care Matters for Kids With Special Needs, but Many Families Report Challenges With Providers

Families with limited resources or inconsistent insurance are more likely to face hurdles, new study finds.

Children and youth with special health care needs (CYSHCN) who receive family-centered care generally have better health outcomes, research shows. When health care providers engage and prioritize the needs of the family, CYSHCN enjoy better overall health; better access to coordinated, ongoing, comprehensive health care within a medical home; fewer emergency department visits; and fewer unmet health needs.

Yet in the United States, CYSHCN families from disadvantaged groups face barriers to receiving high-quality family-centered care, according to a new analysis of national survey data by Paul Morgan, now at the University at Albany, SUNY, and colleagues at Penn State University and SRI International.1

The researchers assessed family-centered care by measuring the extent to which doctors or other health providers:

  • Spent enough time with the child.
  • Listened carefully.
  • Showed sensitivity to the family’s values and customs.
  • Provided the family with specific information they need concerning the child.
  • Helped the family feel like a partner in the child’s care.

Data were from the 2016–2019 National Survey of Children’s Health (NSCH), which uses a five-question screener to identify CYSHCN.

The study focused on the quality of care received by CYSHCN families in visits to health professionals in the previous year and controlled for potentially confounding factors including children’s general health status and the severity of their impairments.

Socioeconomic Background Is Tied to the Quality of Family-Centered Care

Morgan and colleagues found that some CYSHCN families report greater barriers to receiving high-quality family-centered health care, including:

  • Families without consistent health insurance coverage.
  • Poor and lower-income families.
  • Single-parent families.
  • Families who usually receive care in a clinic or health center, emergency room, or other setting outside a doctor’s office.
  • Families of children with autism spectrum disorders, anxiety, or depression.

By contrast, families of CYSHCN with asthma—the most commonly reported special health care need—were significantly more likely to receive family-centered care than families of CYSHCN without asthma.

The results did not show consistent racial/ethnic disparities across all the measures of family-centered care—a finding that surprised the researchers. However, families of Black and Hispanic CYSHCN reported that providers spent relatively less time with their children compared with families of white CYSHCN. Families of Hispanic CYSHCN also said that providers showed less sensitivity to their family’s culture and customs.

A Targeted Approach Could Help Improve Care

Evidence from the study suggests that socioeconomic factors, rather than race or ethnicity, are central drivers of disparities in family-centered care among CYSHCN in the United States. To address these disparities, policies and systems of care serving these young people and their families can adopt comprehensive, coordinated approaches to increase provider-family engagement, cultural responsiveness, and shared decision-making, the authors noted.

To help particularly vulnerable CYSHCN families, targeted actions should focus on care provided in emergency departments, community clinics/health centers, and other non-office settings, and on providers caring for children with autism spectrum disorders or internalizing disorders, the authors suggested.

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from Penn State University was highlighted.



  1. Paul L. Morgan et al., “Disparities in Family-Centered Care Among U.S. Children and Youth With Special Health Care Needs,” The Journal of Pediatrics 253 (2023): 297-303.e6.
Middle school students boarding a bus

Anti-Poverty Tax Credits Linked to Declines in Reports of Child Neglect, Youth Violence, and Juvenile Convictions

A temporary expansion of the child tax credit helped fuel a dramatic drop in child poverty in 2021.

Anti-poverty tax credits provide more than financial relief for families living on tight budgets—they also appear to help prevent trauma, violence, and crime among children and youth, three studies from the University of Washington (UW) show. And these credits may cut child poverty without affecting parents’ workforce participation, other new studies show.

Researchers with the UW Center for Studies in Demography and Ecology found that the child tax credit (CTC) and earned income tax credit (EITC) are related to declines in reports of child maltreatment, youth violence, and juvenile convictions.

The CTC and EITC are among the largest anti-poverty programs in United States, notes Ali Rowhani-Rahbar, a UW epidemiology professor and study co-author. “While not originally designed to prevent violence, we find meaningful reductions in several forms of violence per each $1,000 increase in EITC provided,” he adds.

This new research comes as policymakers at both the national and state levels are considering proposals to expand these tax credits. Child poverty fell more than 40% between 2020 and 2021 thanks to a temporary one-year expansion of the CTC—part of the government’s pandemic response.1

In 2022, the EITC lowers moderate- and low-income workers’ tax bills by between $560 and $6,935, depending on family size, income, and filing status; taxpayers receive a payment if the EITC they qualify for is higher than their tax bill.2 The CTC lowers parents’ taxes by $2,000 per child in 2022; families who owe little or no taxes may still receive a partial payment of up to $1,500.

Tax Credits Linked to Immediate, Short-Term Reductions in Reports of Child Maltreatment

The UW researchers found a significant drop in state-level reports of child maltreatment in the period after tax filers received refunds including the EITC and CTC.3 Specifically, for each additional $1,000 in per-child EITC and CTC refund, state reports to child welfare authorities declined 5% in the five weeks following the payments, they report.

Child maltreatment disproportionately affects children in poverty, the researchers note. “Because refundable tax credits are delivered to families as a lump-sum payment with their tax refunds, these credits create unusual ‘financial slack’ at tax time for low-income families living on a tight budget,” they write.

“Most victims of child maltreatment experience neglect,” explains Heather Hill, a UW professor of public policy and management and study co-author. “The definition of neglect overlaps substantially with poverty and material hardships—for example, not providing children with sufficient food, clothing, or medical care. For that reason, income support may reduce child maltreatment directly by increasing income and reducing material hardships or indirectly by reducing parental stress and improving parenting.”

“Increased income could also help parents afford an improved child care arrangement and prevent mothers from re-partnering with someone who is not the child’s biological father out of economic necessity,” Rowhani-Rahbar adds.

For the study, the research team compared EITC and CTC refund data from the Internal Revenue Service to state-specific child maltreatment report data from the National Data Archive on Child Abuse and Neglect for 48 states and the District of Columbia. They examined tax seasons 2015 through 2018, a period when the timing of payments changed because of the PATH (Protecting Americans Against Tax Hikes) Act. The drop in child maltreatment reports continued to correspond to the receipt of tax refunds despite the change in timeline.

“The generosity of these anti-poverty programs matters,” Rowhani-Rahbar says. “Even relatively small increases in income may lower the risk of maltreatment by reducing economic stress and supporting parents’ capacity to engage in nurturing behaviors.”

Youth Report Fewer Physical Fights and Juvenile Convictions With Higher Family EITC Benefits

More than half of states offer working families additional EITCs—with some state payments more generous than others. The UW researchers found that high school students report significantly less physical fighting in states with higher EITCs.4 Specifically, a 10-percentage point greater state EITC was associated with nearly 4% fewer physical fights. The effect was particularly notable among males.

Previous research shows higher levels of household poverty make it more likely that children will experience physical aggression, fighting, and bullying, according to the researchers. Residents of disadvantaged neighborhoods are more likely to be assaulted, robbed, and carry a weapon, they note.

The researchers suggest that EITC benefits “could reduce youth violence by relieving parental stress, preventing harsh parenting and family conflict, allowing families to move to safer and more cohesive neighborhoods with more economic opportunity, and enabling families to invest in ways that protect youth from violence.” These investments could include tutoring, youth sports, or enrichment programs that “provide more supervision and fewer opportunities for delinquency,” notes Hill.

For the study, the researchers analyzed state-level EITC generosity and self-reports of physical violence among high schoolers in the previous year using Youth Risk Behavior Surveillance System data from 2005 to 2019. They accounted for changes in state EITC levels and differences in state GDP, welfare payments, and minimum wages.

This study provides “some of the first evidence that a cash transfer program can serve as a prevention strategy for youth violence,” Rowhani-Rahbar says.

A related UW study links each additional $1,000 in total EITC benefits a child’s family receives before their 14th birthday with an 11% lower risk of self-reported criminal conviction during adolescence.5

Those findings are based on an analysis of the 1979 National Longitudinal Study of Youth, which interviewed U.S. adolescents born between 1979 and 1998 at ages 15 to 19. The researchers estimated total family EITC benefits based on federal, state, and family-size eligibility differences and payment levels during the study period.

Income support for low- and middle-earning families may reduce a teenager’s risk of involvement with the criminal justice system, particularly among boys, the research team concludes.

“Multiple forms of violence—child maltreatment, youth violence, intimate partner violence, suicide—are interconnected and often share the same root causes, such as lack of economic opportunities and unemployment,” Rowhani-Rahbar explains. “Policies that support income conceivably could reduce the risk of all these forms of violence.”

Payments May Cut Child Poverty Without Reducing Parents’ Workforce Participation, Says New Evidence

For the largest reduction in child poverty, expand the EITC, argue researchers with Columbia University’s Population Research Center who analyzed state anti-poverty programs.6

They assessed the potential impact on child poverty levels if all states adopted policies that mirrored the most generous and inclusive states on the EITC and three other key state-administered programs—state CTC, Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps), and Temporary Assistance for Needy Families (TANF).

Adopting the most generous state EITC policy from 2010 would have the biggest effect on child poverty—nearly 2.7 million children’s families would no longer live below the poverty line, they found.

And a total of 5.5 million children would be pulled out of poverty “if all states adopted the most generous or inclusive state policy in all four policy areas,” they reported, noting that the true number is likely higher.

Another recent study found that the temporary 2021 CTC expansion reduced food insecurity and material hardship for the lowest-income families without affecting their workforce participation.7

Researchers with the University of Michigan’s Population Studies Center report that the CTC recipients they surveyed—predominantly single mothers with monthly incomes below $2,000—were much less likely to report they had trouble providing food for their families and somewhat less likely to have problems paying other bills such as for utilities. The researchers report they found no effect on recipients’ labor force participation, which they suggest should reassure policymakers concerned that the expanded CTC payment are a disincentive to work.

While the UW studies examining the impact of tax credits on violence were not designed to compare the full costs and benefits of EITC and CTC expansion, in Hill’s view, these anti-poverty policies can be cost effective, as childhood experiences have lifelong implications for health and well-being.

“Interventions in childhood have the largest potential for returns on investment,” explains Hill. “Reductions in child maltreatment and youth convictions have substantial benefits for both children, parents, and society because the systems designed to deal with those problems are so costly.”

The costs of administering the EITC and CTC are low compared to other types of programs such as a preschool or employment training, Hill argues. “When you put together relatively low administration costs with potentially huge savings on interactions with the child welfare and criminal justice systems, we can be optimistic about the benefits outweighing the costs in the long run.”

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded Population Dynamics Research Centers was highlighted: University of Washington, Columbia University, and University of Michigan.



[1] Kalee Burns, Liana Fox, and Danielle Wilson, “Child Poverty Fell to Record Low 5.2% in 2021,” U.S. Census Bureau, Sept. 13, 2022.

[2] Internal Revenue Service, “Earned Income and Earned Income Tax Credit (EITC) Tables.”

[3] Nicole L. Kovski et al., “Short-Term Effects of Tax Credits on Rates of Child Maltreatment Reports in the United States,” Pediatrics 150, no. 1 (2022): e2021054939.

[4] Kimberly Dalve et al., “Earned Income Tax Credit and Youth Violence: Findings from the Youth Risk Behavior Surveillance System,” Prevention Science 23, no. 8 (2022): 1370-1378.

[5] Caitlin A. Moe et al., “Cumulative Payments Through the Earned Income Tax Credit Program in Childhood and Criminal Conviction During Adolescence in the US,” Journal of the American Medical Association 11, no. 5 (2022): e2242864.

[6] Jessica Pac et al., “Reducing Poverty Among Children: Evidence From State Policy Simulations,“ Children and Youth Services Review 115 (2020): 105030.

[7] Natasha Pilkauskas et al., “The Effects of Income on the Economic Wellbeing of Families With Low Incomes: Evidence From the 2021 Expanded Child Tax Credit,” National Bureau of Economic Research (NBER), Working Paper 30533, October 2022.

Frustrated student

More Sleep Could Improve Many U.S. Teenagers’ Mental Health

California now requires most high schools to start no earlier than 8:30 a.m. to support students’ well-being and safety.

Most American teenagers are sleep deprived: Fewer than one in four U.S. high school students gets the recommended eight hours of sleep per night.1

Researchers who study the relationship between sleep and depression are unanimous: Adequate sleep could greatly improve many U.S. teenagers’ mental health.

“Perpetually fatigued adolescents look and feel depressed,” says Rachel Widome of the University of Minnesota. Her research links adequate sleep to fewer symptoms of depression among teenagers.2

“Poor sleep and depression are reinforcing—depression interferes with sleep, and not enough sleep leaves someone feeling like they don’t have energy to engage in life, which is a symptom of depression.”

The notion that anyone “can push through on little sleep with little cost to mental health is a myth,” says Andrew Fuligni of the University California, Los Angeles. His research demonstrates that despite some individual variation, most teenagers need about 8.5 hours of sleep to function at their best.3

“Mental health is very sensitive to sleep,” he explains. “To operate at peak levels—emotionally and intellectually—most teens should sleep between eight and 10 hours each night. Less than seven and more than 11 hours is unhealthy.”

Mounting Evidence Shows Later High Schools Start Times Are Key to Better Sleep

Telling teenagers to go to bed earlier is not the answer. The entire circadian-driven sleep cycle—both sleep and wake times—is temporarily pushed later in adolescence because of hormonal changes, Fuligni explains. Child health advocates have been calling for later school start times since the 1980s and 1990s, he notes.

Growing scientific evidence on the benefits of later school start times is behind a new California law, which goes into effect July 1, 2022, that will bar most high schools from starting classes before 8:30 a.m.

The key findings spurring school districts to consider later school start times come from Widome and colleagues, who tracked students at five public Minnesota high schools using wrist monitors (actigraphy) that accurately measured the students’ sleep.4 They showed that when schools instituted later start times, students slept longer and their need for catch-up sleep on the weekends shrank. Students’ bedtimes did not move with the later start time, and they continued to get better sleep over two years.

Additional evidence comes from analysis of a multi-year study conducted by Kayla Wahlstrom and colleagues at the University of Minnesota.5 They examined data on more than 9,000 students attending eight high schools in three states that switched to later start times and documented improved sleep. When schools started after 8:30 a.m., attendance, standardized test scores, and academic performance in math, English, science, and social studies increased, while tardiness declined. One school that shifted start times from 7:35 a.m. to 8:55 a.m. saw a 70% decline in the number of local car accidents among drivers ages 16 to 18.

Despite the documented benefits of later school start times, only about 15% of U.S. high schools start at 8:30 a.m. or later, while 42% start before 8:00 a.m., Widome reports. “Early high school start times are strictly a United States phenomenon,” she notes. “Europe and Australia do not start school so early.”

Some parents and school officials have voiced opposition to changing school start times because the current timing facilitates after-school sports and allows the same school buses to transport high schoolers early in the morning and young children afterward. Family schedules are also often built around early start times that enable “the older kids to get home first to watch the younger ones,” she says.

“It’s appalling that our nation is willing to accept that teens are extremely fatigued during their adolescent years,” says Widome, “when there is a straightforward evidence-based solution—starting school later.”

Teenagers’ Mental Health Problems Rose as Adequate Sleep Declined

The mental health crisis among American youth began growing long before the coronavirus pandemic: In 2019, more than one in three high school students reported “persistent feelings of sadness or hopelessness,” representing a 40% increase from 2009, according to the U.S. Centers for Disease Control and Prevention (CDC).6

During that same period, teenagers’ nightly sleep dropped sharply: The share of high school students getting the recommended minimum of eight hours of sleep declined from nearly 31% in 2009 to around 22% in 2019.7

Research shows a strong connection between sleep and symptoms of depression. In a 2019 study, Widome and colleagues showed that about one in three students who slept less than six hours per night had a high number of depression symptoms compared with about one in 10 students who got adequate sleep.8 But inadequate sleep is one of many factors affecting teenagers’ mental health.

The rise in sleep-deprived teenagers is a long-term trend, reports Widome. “A lot in our society has changed in the last decade, including more time spent using screens—phones, games, computers—and marketing caffeine drinks to adolescents.” In her 2019 study, teenagers who had inadequate sleep tended to spend twice as much time on devices with screens than their peers and were more likely to use those devices after they went to bed.

“We know people feel better when they get enough sleep,” notes Widome. “If we improved sleep, how much of that is addressing the tiredness that looks like depression? It is easy to forget how critically important sleep is to our lives.”

What Biology Tells Us About the Connections Among Sleep, Stress, Depression, and Disease

One way that poor sleep appears to heighten the risk of depression is by activating the body’s stress response system. Fuligni and colleagues identified altered levels of cortisol—the stress hormone—in the saliva of teenagers with consistently inadequate sleep.9 In a related study, the researchers showed that inadequate sleep exacerbated the connection between daily stress and inflammation-triggering genes, another biological sign of stress.10

Poor sleep can keep the body’s stress response system on high alert long term, which can have a profound impact on many of the body’s systems—not just increasing the risk of depression but laying a foundation for chronic conditions such as heart disease later in life, according to Fuligni.

The researchers found that students in 10th and 11th graes who consistently reported inadequate sleep were more vulnerable to depression several years later.11 Interventions designed to improve sleep during the high-school years may prevent depression among young people in their early 20s, when an individual’s risk of depression is highest, the researchers suggest.

Additional Strategies for Improving Teenagers’ Sleep

Starting high schools later in the morning is the number one way to improve teenagers’ sleep, both Fuligni and Widome say. They express concerns over legislation to make Daylight Saving Time permanent because more high school students would go to school in the dark and wouldn’t see the sun rise until after their first period classes.

Widome favors permanent Standard Time, which would set sunrise earlier—helpful to teenagers’ waking—despite earlier evening sunsets. Both Fuligni and Widome agree that the current switch from Daylight Saving Time that moves clocks ahead in spring is a challenging adjustment for teenagers.

Along with later school start times, Fuligni would like to see school administrators and teachers assess whether students are sacrificing sleep for homework and adjust their expectations. If Widome were making school policy, she also would eliminate online assignments that have midnight due dates and ban high school clubs from meeting before 8:00 a.m.

“We need to really value sleep,” she says, “not see it as something extraneous that is only for the weak.”

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded Population Dynamics Research Centers was highlighted: University of Minnesota (5P2CHD041023-19) and University of California, Los Angeles (5P2CHD041022-19).


[1] Centers for Disease Control and Prevention (CDC), High School Students Who Got 8 or More Hours of Sleep, YRBS Explorer.

[2] Aaron T.  Berger, Kyla L. Wahlstrom, Rachel Widome, “Relationships Between Sleep Duration and Adolescent Depression: A Conceptual Replication,” Sleep Health 5, no. 2 (2019): 175-9, doi:10.1016/j.sleh.2018.12.003.

[3] Andrew J. Fuligni et al., “Individual Differences in Optimum Sleep for Daily Mood During Adolescence,” Journal of Clinical Child and Adolescent Psychology 48, no. 3 (2019): 469-79.

[4] Rachel Widome et al., “Association of Delaying School Start Time With Sleep Duration, Timing, and Quality Among Adolescents,” JAMA Pediatrics 174, no. 7 (2020): 697-704, doi:10.1001/jamapediatrics.2020.0344.

[5] Kayla L. Wahlstrom et al, Examining the Impact of Later School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study (Center for Applied Research and Educational Improvement, University of Minnesota, St. Paul, MN: 2014).

[6] CDC, “Adolescent and School Health: Mental Health,” n.d.

[7] CDC, High School Students Who Got 8 or More Hours of Sleep.

[8] Rachel Widome et al., “Correlates of Short Sleep Duration Among Adolescents,” Journal of Adolescence 77 (2019): 163-7.

[9] Kate Ryan Kuhlman et al., “Sleep Problems in Adolescence Are Prospectively Linked to Later Depressive Symptoms Via the Cortisol Awakening Response,” Developmental Psychopathology 32, no. 3 (2020): 997-1006.

[10] Jessica J. Chiang et al., “Daily Interpersonal Stress, Sleep Duration, and Gene Regulation During Late Adolescence,” Psychoneuroendocrinology 103 (2019): 147-55, doi: 10.1016/j.psyneuen.2018.11.026.

[11] Kate Ryan Kuhlman et al., “Persistent Low Positive Affect and Sleep Disturbance Across Adolescence Moderate Link Between Stress and Depressive Symptoms in Early Adulthood,” Journal of Abnormal Child Psychology 48, no. 1 (2020): 109-21, doi: 10.1007/s10802-019-00581-y.


Climate Change and Pollution Affect How Communities Plan, Adapt, and Mitigate Risk

Environmental forces like wildfire, extreme heat, and pollution can have profound effects on our health, jobs, and decisions on where to live.

Wildfire. Drought. Lead Exposure. Oil spill.

Environmental events and changes can have profound effects on our health and jobs and help shape our decisions on where we live.

A new, special issue of the journal, Population and Environment, explores the ways that environmental forces shape people’s lives and behaviors, and identifies policy approaches community leaders can use to plan, adapt, and mitigate risks in specific settings worldwide.

The featured studies draw on the expanding availability of environmental data, which reflects growing interest in the human implications of climate change and the increasing frequency of extreme weather events, report Katherine Curtis, Marcy Carlson, and Malia Jones of the University of Wisconsin-Madison, editors of this special issue.

Much of the research in this journal issue grapples with the impact of dynamic forces in the natural environment on child health and migration:

  • U.S. children exposed to air pollution and household lead face a higher risk of incarceration and lower incomes in adulthood.1 The study also linked high levels of air pollution—disproportionately found in Black and Latino neighborhoods—to a greater likelihood of teen childbearing. White children were much less likely to be exposed to either air pollution or household lead, suggesting that efforts to clean up neighborhood toxins could increase social mobility and decrease inequality. Policy Summary.
  • Children whose families lost income or jobs related to the BP Deepwater Horizon oil spill were more likely to have persistent health problems.2 Children affected by the oil spill had poorer health compared with their peers, whether they had physical contact with toxins or their household lost jobs or income because of the disaster. While the effects of physical exposure to the oil spill dissipated over time, the effects of related job or income loss persisted. These findings underscore the need for policies and programming that better support the long-term health of children who have experienced a disaster. Policy Summary.
  • Climate change-related declines in water availability impact child health and growth in West Africa’s Sahel region.3 Child health and growth suffer in Burkina Faso, Mali, and Senegal when the quality and quantity of surface water (waterholes) declines, analysis shows. These countries are already experiencing chronic food insecurity and childhood malnutrition, and their rapidly growing populations are dependent on livestock and crops in a region predicted to experience hotter and drier conditions. Research results highlight the potential importance of monitoring waterholes and ensuring clean drinking water is available locally for the health of people—especially children—and livestock. Policy Summary.
  • Better rainfall linked to more time farming and less time breastfeeding among Ethiopian mothers.4 More favorable rainfall conditions for crop production may impact mothers’ time use, possibly reducing the time they have available to breastfeed their babies, the study finds. This information can help policymakers develop targeted interventions that reflect the dynamic needs of farming households, such as suppling technologies that make planting and harvesting more efficient. Policy Summary.
  • Climate change-induced extreme heat and wildfire dampen migration in U.S. regions high in natural amenities.5Rural counties with outdoor recreation and environmental features such as ample sunshine, dramatic topography, warm and dry climates, and forests are most affected by these migration shifts, researchers find. Policymakers and planners have relied on migration models that predict more people moving to U.S. counties rich in amenities, but climate change is likely to alter migration trends, impacting economic development. Policy Summary.
  • Repeated droughts in rural Thailand and Vietnam trap poorer households, reducing migration.6 Both household assets and consumption shrink in rural areas that have experienced two years of drought, analysis shows. Particularly among poorer households, this decrease creates an obstacle to those who would migrate for income-earning opportunities. As extreme weather events like drought become more frequent and severe, the need for safety nets and social protection programs, such as cash transfer and insurance programs, becomes crucial, especially when targeted to poorer households. Policy Summary.

Extreme Weather Hits Under-Resourced People Hardest; Research to Support Climate Adaptation Crucial

“Environmental shocks and stressors expose and often exacerbate existing inequalities, taking the greatest toll on the most disadvantaged people,” note Curtis, Carlson, and Jones. They point to the tsunami in Southeast Asia (2004) and Hurricane Katrina in New Orleans (2005) as examples.

The resources and infrastructure needed to plan and adapt to climate events are unevenly distributed around the globe, underscoring the importance of linking scholars with policymakers, they argue.

Recent technological advancements mean that the data and tools needed to identify ways to mitigate climate-related risks are available, notes Barbara Entwisle of the University of North Carolina at Chapel Hill in a piece in the special issue.7 Demographers are poised to “contribute significantly to a larger and deeper understanding of environmental change and its consequences, locally, regionally, and globally,” she writes.

But as researchers work with data linked to specific geographic locations, they must strike a balance between privacy and accuracy so that confidentiality is not breached, Lori Hunter of the University of Colorado, Boulder and colleagues assert in another article in the journal.8 The authors compare unaltered data from surveys and vegetation information from rural South Africa with similar data generated by a series of geomasking techniques designed to reduce the likelihood that individual respondents can be identified. They find that geomasking approaches that use buffers and account for population density produce the most accurate results. But they also show that higher levels of accuracy increase the likelihood that potential respondents can be identified.

Yet the challenges of this research should not be an obstacle, argue Curtis, Carlson, and Jones. “Environmental change is happening. Environmental events are occurring,” they write. “These environmental forces have demonstrable consequences for human lives and livelihoods and, by extension, for the welfare” of the entire human family.

The special issue of Population and Environment is based on a conference supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (Grant HD 096853).


  1. Robert Manduca and Robert J. Sampson, “Childhood Exposure to Polluted Neighborhood Environments and Intergenerational Income Mobility, Teenage Birth, and Incarceration in the USA,” Population and Environment 42, no. 4 (2021).
  2. Tim Slack et al., “Deepwater Horizon Oil Spill Exposure and Child Health: A Longitudinal Analysis,” Population and Environment 42, no. 4 (2021).
  3. Kathryn Grace and Frank Davenport, “Climate Variability and Health in Extremely Vulnerable Communities: Investigating Variations in Surface Water Conditions and Food Security in the West African Sahel,” Population and Environment 42, no. 4 (2021).
  4. Heather Randell, Kathryn Grace, and Maryia Bakhtsiyarava, “Climatic Conditions and Infant Care: Implications for Child Nutrition in Rural Ethiopia,” Population and Environment 42, no. 4 (2021).
  5. Richelle L. Winkler and Mark D. Rouleau “Amenities or Disamenities? Estimating the Impacts of Extreme Heat and Wildfire on Domestic US Migration,” Population and Environment 42, no. 4 (2021).
  6. Esteban J. Quiñones, Sabine Leibenehm, and Rasadhika Sharma, “Left Home High and Dry–Reduced Migration in Response to Repeated Droughts in Thailand and Vietnam,” Population and Environment 42, no. 4 (2021).
  7. Barbara Entwisle, “Population Responses to Environmental Change: Looking Back, Looking Forward,” Population and Environment 42, no. 4 (2021).
  8. Lori Hunter et al., “Working Toward Effective Anonymization for Surveillance Data: Innovation at South Africa’s Agincourt Health and Demographic Surveillance Site, Population and Environment 42, no. 4 (2021).




U.S. Racial Inequality May Be as Deadly as the Coronavirus

The mortality rate for Black Americans in non-pandemic years is higher than the mortality rate for white Americans who died from COVID-19 and all other causes in 2020.

Coronavirus Pandemic Temporarily Shortens Average U.S. Lifespan by About a Year

While the pandemic is shortening the average U.S. lifespan—temporarily—its effects will be felt most heavily by Black Americans, whose mortality rate in ordinary years is higher than the rate for white Americans during the pandemic. Each coronavirus-related death will likely impact about nine close family members.

These impacts are among the findings of new research supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) that aims to put the pandemic’s magnitude in context and inform responses.

Extreme Racial Inequality in COVID-19 Deaths Layers on Top of Existing Stark Disparities

Black Americans experience a higher mortality rate every year than white Americans are experiencing during the coronavirus pandemic, finds Elizabeth Wrigley-Field of the University of Minnesota.Her analysis focuses on death rates and compares the scale of this pandemic to racial inequality, which she calls “another U.S. catastrophe.”

Using demographic models, Wrigley-Field estimates how many deaths of white Americans would be needed to raise the white age-adjusted mortality rate to the best-ever (lowest) Black age-adjusted rate.

At least 400,000 excess deaths of white Americans—deaths above and beyond the number expected in a non-pandemic year—would be needed to reach the best mortality rate ever recorded for Black Americans, which occurred in 2014, she finds.

Black Americans’ age-adjusted, confirmed COVID-19 deaths are more than 2.5 times higher than that of white Americans, she reports.2

Social factors rather than innate vulnerabilities drive these mortality differences: Mounting research suggests these stark disparities are driven by differences in exposure to the coronavirus. In particular, Black Americans are overrepresented in service jobs with high public contact and are particularly overrepresented among low-paid workers who may lack the power to demand adequate protection.3

For white mortality to reach levels that Black Americans experience outside of the pandemic, excess mortality in 2020 for white Americans would need to increase by 5.7 times the level of cumulative COVID-19 mortality reached in July 2020 (when the research findings were published), Wrigley-Field reports.

Final analysis of 2020 is likely to reveal “a deadly pandemic causing a spike in mortality for whites that nevertheless remains lower than the mortality Blacks experience routinely, outside of any pandemic,” she suggests.

This disparity in mortality rates has an impact on life expectancy during the pandemic as well. For white Americans, life expectancy in 2020 will remain higher than life expectancy for Black Americans has ever been unless nearly 700,000 excess white deaths occur, Wrigley-Field finds.4

“If Black disadvantage operates every year on the scale of whites’ experience of COVID-19, then so too should the tools we deploy to fight it,” she argues. “Our imagination should not be limited by how accustomed the United States is to profound racial inequality.”

COVID-19 Expected to Shorten the Average U.S. Lifespan in 2020

With the U.S. population as a whole experiencing nearly 350,000 COVID-19 deaths in 2020 and more to come in 2021, life expectancy may appear to be plummeting.5

But in estimating the magnitude of the pandemic, demographers at the University of California, Berkeley have found that COVID-19 is likely to shorten the average U.S. lifespan in 2020 by about a year.6

In July 2020, demographers Ronald Lee and Joshua Goldstein calculated the consequences of U.S. lives lost to COVID-19 that year in order to put COVID-19 mortality rates into historic, demographic, and economic perspective. They used two scenarios: One based on a projection of 1 million deaths for the year, the other on 250,000 deaths, which is closer to the current estimate of 345,700 deaths by Johns Hopkins University.7

One million deaths in 2020 would cut about three years off the average U.S. life expectancy, they conclude, while 250,000 deaths would reduce lifespans by about 10 months.

That said, without the societal efforts implemented to lessen COVID-19’s impact, 2 million deaths were projected by the end of 2020—a reduction of the average U.S. lifespan by five years, the researchers point out.

Their estimated drop in life expectancy is modest, in part because 250,000 deaths is not a large increase on top of the 3 million non-COVID-19 deaths expected for 2020. The study also notes that older people, who typically have fewer remaining years of life than others do, represent the most COVID-19 fatalities.

Still, while COVID-19 mortality rates in general remain lower than those of the 1918 Spanish flu pandemic, the toll of the coronavirus in the United States could be just as devastating as the country’s longer-lasting HIV and opioid epidemics if mitigation efforts fail, the researchers said.

“The death toll of COVID-19 is a terrible thing, both for those who lose their lives and for their family, friends, colleagues, and all whom their lives touched. Those are real people, not abstract statistics,” says Lee.

“But the population perspective helps put this tragedy in a broader context. As we work to contain the coronavirus, it is important to know that the United States has been through such mortality crises before,” he adds.

About Nine Close Relatives Suffer Grief With Each COVID-19 Fatality

The ripple effects of each COVID-19 death will impact the mental and physical health of about nine surviving close family members, a study of kinship networks shows.8

For example, when 190,000 people were dead from the disease in September 2020, 1.7 million Americans experienced the loss of a close relative, explains Ashton Verdery of Penn State University. A kinship network includes grandparents, parents, siblings, spouses, and children. Black Americans had a slightly higher number of close relatives than white Americans, averaging an estimated 9.2 people compared with 8.9, they found.

If 1 million people eventually die from COVID-19, then 8.9 million—or about 3 out of 100 Americans—would be in mourning.

These findings can help raise awareness about the scale of the disease and the ripple effects that deaths may have on a community, as well as prepare officials and business leaders to manage those effects, according to Verdery.

“It’s very helpful to have a sense of the potential impacts that the pandemic could have,” he says. “And, for employers, it calls attention to policies around family leave and paid leave. At the federal level, it might inform officials about possible extensions for FMLA (Family and Medical Leave Act). There could also be some implications for caretaking. For example, a lot of children grow up in grandparent-led houses and they would be impacted.”

Many people are also facing the loss of a close loved one at a younger age because of the disease, according to Verdery, who worked with Emily Smith-Greenaway of the University of Southern California, Rachel Margolis of the University of Western Ontario, and Jonathan K. Daw at Penn State.

“There are a substantial number of people who may be losing parents that we would consider younger adults and a substantial number of people may be losing spouses who are in their 50s or 60s,” he suggests.

Their findings could help local officials understand and prepare for the waves of grief that may affect specific geographic areas and regions of the country.

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Yasmin Anwar of the University of California Berkeley and Matt Swayne of Penn State University contributed to this article. The work of researchers from the following NICHD-funded Population Dynamics Research Centers was highlighted: University of California, Berkeley (2P2CHD073964-05A1); University of Minnesota (5P2CHD041023-19); and Penn State University (5P2CHD041025-19).

A list of newly published research on the pandemic by NICHD Population Dynamics Research Centers can be found here.


  1. Elizabeth Wrigley-Field, “U.S. Racial Inequality May Be as Deadly as COVID-19,” Proceedings of the National Academies of Sciences 117, no. 36 (2020): 21854-6.
  2. Centers for Disease Control and Prevention, “COVID-19 Hospitalization and Death by Race/Ethnicity,” updated Nov. 30, 2020,
  3. Noreen Goldman et al., “Racial and Ethnic Differentials in COVID-19-Related Job Exposures by Occupational Status in the US,” MedRxiv (2020),
  4. This study does not examine life expectancy for non-Hispanic Black Americans and non-Hispanic White Americans separately by sex. PRB notes that in 2017, non-Hispanic Black females had a longer life expectancy (78.1 years) than non-Hispanic White males (76.1 years). Data on life expectancy are from Kenneth D. Kochanek et al., “Deaths: Final Data for 2017,” National Vital Statistics Reports 68, no. 9 (2019).
  5. Johns Hopkins University, Coronavirus Resource Center, accessed on Jan. 4, 2021,
  6. Joshua R. Goldstein and Ronald D. Lee, “Demographic Perspectives on the Mortality of COVID-19 and Other Epidemics,” Proceedings of the National Academies of Sciences 117, no. 36 (2020): 22035-41.
  7. Johns Hopkins University, Coronavirus Resource Center, accessed on Jan. 4, 2021,
  8. Ashton M. Verdery et al., “Tracking the Reach of COVID-19 Kin Loss With a Bereavement Multiplier Applied to the United States,” Proceedings of the National Academies of Sciences 117, no. 30 (2020): 17695-701.
Pouring Cola

Taxes, Health-Warning Labels May Help Limit Consumption of Sugary Beverages and Improve Health

To combat obesity and diabetes, lawmakers in a number of U.S. cities have taxed sodas, sports drinks, and sweetened tea, and many are now considering health warning labels.

Growing evidence suggests that both strategies—taxes and warning labels—can reduce the purchase and consumption of sugary drinks, research supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) shows.

Health-Warning Labels Influence What People Buy and Consume

Even brief exposure to health warnings on sugar-sweetened beverages reduces purchases of those beverages, providing evidence that such warnings can promote healthier drink choices, a new study demonstrates.1

A team of researchers from the University of North Carolina at Chapel Hill (UNC)—including Anna Grummon, Lindsey Smith Taillie, Shelley Golden, Marissa Hall, and Noel Brewer—examined how health warnings influence what consumers actually buy in real settings. This randomized controlled trial assigned 400 consumers of sugary beverages to groups that saw either a health warning or a label that looked like a barcode.

“We worked in a convenience-store laboratory that allowed us to control whether the sugary drinks had warnings,” explains Grummon, now at Harvard University. “We are also one of the first studies to measure what consumers actually buy after seeing warnings, when they have their own money on the line.”

Participants who saw the health warning labels purchased about 22% fewer calories from sugary drinks compared with participants who saw a neutral label. The study also found that the warnings were influential across diverse groups: The effect of health warnings on beverage purchases did not differ by participants’ race/ethnicity, education, age, gender, sexual orientation, income, body weight, or health-literacy level.

According to Grummon, critics of health warning labels argue that consumers won’t notice or pay attention to the warnings. However, three-quarters of the participants in this study reported noticing the health warnings, and most of those participants also reported that they read and looked closely at the labels.

In another study, Grummon and Hall synthesized the findings of 23 studies and found that health warnings labels not only reduced purchases of sugary drinks but also caused stronger emotional responses, increased perceptions that sugary drinks contribute to disease, and reduced intentions to purchase or consume sugary drinks.2 All these responses are key indicators when it comes to long-term behavior change, they note.

“Our findings suggest that sugary drink warnings help consumers better understand products’ healthfulness and encourage them to make healthier choices about what drinks to buy,” says Grummon.

In a related mathematical simulation, UNC researchers show that a national policy requiring health labels on sugar-sweetened beverages could reduce obesity prevalence by about 3.1 percentage points over five years, if sustained.3

“While three percentage points might sound modest, on a national scale it equates to more than five million fewer people with obesity,” says Grummon. “Warnings are a highly scalable strategy for helping consumers make healthier choices. These findings suggest that warnings are also promising for addressing obesity in the U.S.”

Improved Child Health Projected in Wake of Mexico’s Soda Tax

The Mexican government enacted the first national tax on sugar-sweetened beverages after a 2012 study indicated that more than 70% of the country’s population was overweight or obese, and that in excess of 70% of the added sugar calories in the Mexican diet were coming from sugary drinks.

In the two-year period spanning 2014 to 2015, a research team that included Barry M. Popkin and Shu Wen Ng of UNC found that:

  • The one-peso-per-liter excise tax on sugar-sweetened beverages in Mexico resulted in a 6% reduction in purchases of taxed beverages during the first year and continued to decline, with a 10% decrease in purchases in the second year.
  • During the same study period, purchases of untaxed beverages such as bottled water increased 2.1%.
  • Residents of households with lower socioeconomic levels, for whom health care costs are most burdensome, reduced their purchases of sweetened beverages the most.4

The findings run counter to initial reports from the sugar-sweetened soda industry, which said that the purchases of sugary drinks actually went up after the initial tax year. However, the researchers found those reports did not account for numerous significant factors, including inflation and shifts in population.

In addition, a new analysis co-authored by Popkin estimates that Mexico’s sugar-sweetened beverage tax could result in meaningful weight control and life-long health benefits for the country’s children and adolescents, particularly those who had been high consumers of the beverages before the tax.5 Childhood obesity is a strong predictor for obesity later in life, which can also lead to chronic illnesses such as diabetes, hypertension, and heart disease, the researchers emphasize.

To estimate the one-year effect of the tax on the body weight of children ages 5 to 17, by taking into account patterns of childhood growth and obesity in Mexico and assuming that the known reductions in sugar-sweetened beverage purchases would reflect changes in consumption.

Findings show that one year after the implementation of the current tax, children and adolescents should experience an average reduction in body weight of 0.26 and 0.61 kg (one kilogram equals about 2.2 pounds). For those who had been high consumers of sugary drinks, the team estimates the positive impact on body weight would be even greater, with an average body weight reduction of 0.50 kg for children and 0.87 kg for adolescents. Sustained over several years, such weight loss could mean some children and adolescents would not longer be considered obsese.

“Taxation represents one of the most effective ways to reduce consumption of unhealthy sugar-sweetened beverages, which can make a meaningful impact on future excessive weight gain and significantly reduce the long-term risks of becoming obese,” says Popkin. “If the taxation revenue is used to support child and adolescent healthy eating, then the benefits of such taxes are enhanced.”

Public Support Is Key to Policies Limiting Sugary Beverages

For taxes on sugary beverages to become a widely used strategy for improving public health, public support and acceptance are key.

Public opinion on the policies’ unintended consequences may affect attitudes toward the policy, argue Melissa Knox, Jessica Jones-Smith, and Vanessa Oddo of the University of Washington, who analyzed perceptions of the effects of Seattle’s 2017 sugary beverage tax.6

“We find that a majority of participants (59%) support the sugary beverage tax in Seattle and correspondingly, most people believed that the tax will positively impact health, and will not negatively affect general and personal economics in Seattle,” they report. “However, lower-income, versus higher-income, respondents were more concerned about the possible negative economic consequences of the tax,” such as job loss or increased financial costs for their family and friends.

A related study shows that attitudes toward sugary beverage taxes may be difficult to accurately estimate in phone surveys.7 Phone respondents (but not web respondents) under-report their sugary beverage consumption by about 25% and over-report positive attitudes toward the tax by about 11%, the researchers determined. These differing results likely reflect respondents’ answering interviewers’ questions in ways they believe are more socially desirable or acceptable rather than choosing responses that reflect their true thoughts or feelings, a tendency known as social desirability bias.

The researchers offer advice to lawmakers implementing soda taxes.

  • Policymakers “should be wary of solely relying on self-reported measures of intake when evaluating the effectiveness of these policies,” they write, noting that consumers may consume more sweetened beverages than they report.
  • Lawmakers should strengthen “their public messaging regarding the health and economic benefits of sweetened beverage taxes, even if they believe that attitudes are generally positive. Without a pro-tax messaging campaign that informs the public about the positive health and economic effects of these taxes, the taxes may eventually lose public support.”

The researchers point out that “recent successful efforts to block U.S. municipalities from enacting future beverage taxes by banning the taxes at the state level have relied heavily on informational campaigns that focused on the negative economic effects of the taxes. These campaigns, often funded by the beverage industry, may ultimately shift social norms in the direction of more favorable attitudes toward sweetened beverages, with unpredictable effects on public health.”

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The Communications and Marketing team at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill contributed to this article. The work of researchers from the following NICHD-funded Population Dynamics Research Centers was highlighted: University of North Carolina at Chapel Hill (P2CHD050924) and University of Washington (5P2CHD042828-18).



  1. Anna H. Grummon et al., “Sugar-Sweetened Beverage Health Warnings and Purchases: A Randomized Controlled Trial,” American Journal of Preventive Medicine 57, no. 5 (2019): 601-10.
  2. Anna H. Grummon and Marissa G. Hall, “Sugary Drink Warnings: A Meta-Analysis of Experimental Studies,” PLOS Medicine (2020),
  3. Anna H. Grummon et al., “Health Warnings on Sugar-Sweetened Beverages: Simulation of Impacts on Diet and Obesity Among U.S. Adults,” American Journal of Preventive Medicine 57, no. 6 (2019): 765-74.
  4. M. Arantxa-Colchero et al., “In Mexico, Evidence of Sustained Consumer Response Two Years After Implementing a Sugar-Sweetened Beverage Tax,” Health Affairs 36, no. 3 (2017):
  5. Rossana Torres-Álvarez et al., “Body Weight Impact of the Sugar-Sweetened Beverages Tax in Mexican Children: A Modeling Study,” Pediatric Obesity 15, no. 8 (2020): e12636,
  6. Vanessa M. Oddo et al., “Perceptions of the Possible Health and Economic Impacts of Seattle’s Sugary Beverage Tax,” BMC Public Health 19 (2019): 910.
  7. Melissa A. Knox et al., “Is the Public Sweet on Sugary Beverages? Social Desirability Bias and Sweetened Beverage Taxes,” Economics & Human Biology 38 (2020): 100886.

Cohabiting Couples in the United States Are Staying Together Longer but Fewer Are Marrying

More unmarried couples today are living together, and doing so for longer than in the past, but fewer of these relationships lead to marriage, new research finds. This change may in part reflect shifting attitudes toward cohabitation, and it results in more separations and re-partnering during young adulthood.

Most young women today will live with a romantic partner at least once, compared with just one-third of young women in the late 1980s.1 During that decade, most cohabiting relationships were short-lived and frequently led to marriage.

The new research, conducted by graduate students and faculty at the Center for Family and Demographic Research at Bowling Green State University, examined how cohabitation and marriage patterns have changed for young women over the past four decades. Their research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

In their study, Esther Lamidi, now at the University of Colorado Colorado Springs, and colleagues Wendy Manning and Susan Brown at Bowling Green, drew on data from the National Survey of Family Growth (NSFG) to compare women ages 15 to 39 who lived with a first romantic partner in 1983-1988 and in 2006-2013.They examined changes in whether couples who lived together had married or split up within five years.

They found that while cohabiting relationships are still relatively short-lived, couples today are cohabiting longer—increasing from about 12 months in the 1983-1988 cohabitation cohort to 18 months in the later cohort—and that this longer duration is linked to couples delaying or forgoing marriage altogether. After five years, similar shares of women in both cohorts were still living with their partner, but the distribution of those still cohabiting as compared to those who had married had shifted. Among the early cohort, 23% of women were still cohabiting five years later, and 42% had married their partner. These shares were reversed among the later cohort—43% were still cohabiting and only 22% had married.

Women With Less Education Experience More Changes in Cohabitation

Over the past five decades, changes in family behaviors such as declining rates of marriage have been more pronounced among women with less education compared with women who have more education. Lamidi and her colleagues confirmed this divergence—similar to what’s been observed in other family behaviors and frequently termed “diverging destinies”—when they examined patterns of cohabitation across different sociodemographic groups.

Their analysis found that the more recent cohort was much less likely to marry their cohabiting partner, and while this pattern was observed across all sociodemographic groups, it occurred more frequently among women with less education.

After accounting for women’s educational attainment, their results show that between the two cohorts only women with less than a college education experienced a decline in marrying their cohabiting partner. In addition, women having one or more children while cohabiting—an occurrence more common among women with less education—delayed or inhibited marriage more for the later cohort than the earlier cohort, they found.

Cohabitation Changes Reveal a Widening Social Class Divide

Sociodemographic characteristics are associated with the pathways out of cohabitation—break ups or marriages—and changes among the cohabiting population’s characteristics can be reflected in changes in cohabitation outcomes. Yet while the researchers noted that the cohabiting population grew in size, became more racially and ethnically diverse and more highly educated, and had more births while living together, they found these compositional changes had little impact on the changes in cohabitation outcomes across the two cohorts.

What does this finding mean? The researchers conclude that the limited impact of population composition changes on cohabitation outcomes, combined with the decline in marrying a cohabiting partner among women with less education, suggests that the social class divide in the American family appears to be widening.

Their findings also “diminish the traditional view of cohabitation as a prelude to marriage” for women with less education and show, particularly for this population, that “cohabitation is increasingly serving a role similar to that of traditional marriage in offering a viable context for childbearing and child-rearing.”

Young Women Today Are Increasingly Likely to Experience a Breakup

Although cohabiting relationships may be lasting longer, they remain relatively unstable. Kasey Eickmeyer, now at the Center for Policing Equity, reports, “Millennials experienced more relationship instability during young adulthood than earlier birth cohorts of women.” She found that cohabitation experience accounted for this instability.

Eickmeyer asked whether young women see their intimate live-in relationships (either marriage or cohabitation) end more frequently today than earlier generations.3 She analyzed data from multiple cycles of the NSFG to examine women’s experience of ending marriages and cohabiting relationships when they were ages 18 to 25 across several five-year birth cohorts from 1960 to 1985.

She found that among women who had ever married or cohabited, the share breaking up with a live-in partner increased from 31% among women born between 1960 and 1964 to 44% among women born in 1985 to 1989.

Cohabitation explains this increasing likelihood of experiencing a breakup. Compared to women in the 1985-1989 birth cohort, women in the earlier birth cohorts from 1960-1964 through 1975-1979 were significantly less likely to have one or more live-in partnerships end. Once Eickmeyer accounted for women’s cohabitation experience, she found that young women’s increased likelihood of having an intimate partnership end is because union formation during young adulthood shifted from marriage—a relatively stable union—to cohabitation, a relatively unstable union.

More Breakups and Re-Partnering in Young Adulthood Suggest Changing Attitudes About Cohabitation

As more young women enter into and end cohabiting relationships, they have more opportunities to live with multiple partners in a pattern of serial cohabitation. The growing practice of serial cohabitation reflects in part changing attitudes about couples living together without marriage.

Eickmeyer and Wendy Manning wanted to know whether contemporary young adult women who had ever cohabited are more likely to re-partner than prior cohorts of young women.4 Using data from the 2002 and 2006-2013 NSFG, they compared the cohabitation experience of young women ages 16 to 28 across five-year birth cohorts beginning in 1960 through 1980 to examine trends in serial cohabitation.

They found that early Millennial women (born 1980-1984) were 53% more likely to live with more than one romantic partner during young adulthood compared with the late Baby Boomers (born 1960-1964), even after taking into account sociodemographic characteristics such as race and ethnicity and educational level, and relationship characteristics such as their age when their first cohabiting relationship ended and whether they had children.

Not only were early Millennial women more likely to live with more than one partner without marriage, they also formed subsequent cohabiting relationships more quickly than the late Baby Boomers—dropping from nearly four years between live-in relationships to just over two years.

The characteristics most strongly associated with serial cohabitation—such as identifying as non-Hispanic white, having less than a college education, and growing up with a single parent—remained stable across birth cohorts, Eickmeyer and Manning found. And, much like the cohabiting population, the composition of women who had previously lived with a partner changed across cohorts, but this shift does not explain the increase in serial cohabitation.

The researchers conclude that the increase stems from more young adults cohabiting, the continued instability of cohabiting relationships, the increasing length of time between first cohabitation and first marriage, and the growing acceptance of cohabitation during young adulthood.

Their findings highlight the instability in many contemporary young adults’ lives and the increasing role cohabitation plays in relationship churning. Although multiple live-in romantic relationships could have negative consequences for young adults’ well-being (and any children they may have), Eickmeyer and Manning suggest “that young adult relationships may be evolving, and young women may be learning to end coresidential relationships that are not working.”

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the NICHD-funded population dynamics research center at Bowling Green State University (P2CHD050959) was highlighted in this article.


  1. Paul Hemez and Wendy D. Manning, Twenty-Five Years of Change in Cohabitation in the U.S., 1987-2013, National Center for Family and Marriage Research Family Profiles, No. FP-17-02 (2017),
  2. Esther O. Lamidi, Wendy D. Manning, and Susan L. Brown, “Change in the Stability of First Premarital Cohabitation Among Women in the United States, 1983-2013,” Demography, 56 (2019): 427-50.
  3. Kasey J. Eickmeyer, “Cohort Trends in Union Dissolution During Young Adulthood,” Journal of Marriage and Family 81 (2019): 760-70.
  4. Kasey J. Eickmeyer and Wendy D. Manning, “Serial Cohabitation in Young Adulthood: Baby Boomers to Millennials,” Journal of Marriage and Family 80 (2018): 826-40.

When a Parent Is Incarcerated, Partners and Children Also Pay a Price

“We live in a country where we have huge numbers of children exposed to parental incarceration. When we talk about the need to reform the criminal justice and mass incarceration systems, we also need to talk about the unintended victims of the current system,” says Christine Leibbrand of the University of Washington. “Incarceration exposes families to poverty and disadvantage, and the system can self-perpetuate inequality.”

About 3.5% of U.S. children under age 18—or one child in every classroom of about 29 students—had a parent behind bars in 2015, mainly their fathers.1

Black children were more than five times more likely than white children to be separated from a parent by incarceration, report sociologists Bryan Sykes of University of California, Irvine and Becky Pettit of University of Texas at Austin. These patterns reflect a system that disproportionately imprisons disadvantaged and minority men, they argue.

A growing body of research documents the toll U.S. incarceration takes on the families of those imprisoned, widening disparities and exacerbating existing disadvantages. New research supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development provides further evidence on the wide-ranging ways a parent’s incarceration shapes the lives and life chances of their partners and children, from the neighborhoods where they live to the levels of adversity their children experience.

Children of Incarcerated Fathers Are More Likely to Live in High-Poverty Neighborhoods and Move More Often

Children whose fathers were incarcerated move more frequently and live in neighborhoods that are more socioeconomically disadvantaged than their peers whose fathers have never been in prison, find Leibbrand and Erin Carll of the University of Washington, Angela Bruns of the University of Michigan now at Gonzaga University, and Hedwig Lee of Washington University in St. Louis.2

Using data from the national Fragile Families and Child Wellbeing Study—research following thousands of families in 20 large U.S. cities since 1998—the team examined the neighborhoods of children whose fathers were in prison or recently released. Families with a father currently or recently in prison tend to live in neighborhoods with higher percentages of residents who are single mothers, receive public assistance, lack a high school diploma, and live below the poverty line, they show.

The financial hardship families with imprisoned members face, researchers say, perpetuates what they call “downward mobility.” A father in prison is one less wage earner at home or paying child support. Families with limited income have fewer choices of where to live, they may move often, and the neighborhoods they end up in may be marked by lower quality schools, greater unemployment, and higher rates of crime and violence, Leibbrand and her colleagues report.

“When we think about where people live or move to, we think of people weighing the pros and cons of different places. That’s far too simple. Many families may be forced to move because of eviction or budget constraints, for example, and these forced moves are often to worse neighborhoods where families have little choice of where they would like to live,” says Leibbrand.

Mothers With a Partner in Prison Are More Likely to Hold Multiple Jobs

Mothers with incarcerated partners are more likely to work multiple jobs than women in otherwise similar circumstances, finds Bruns in another study.3

Partner incarceration is linked to additional employment—a third shift—on top of the paid work and caregiving women already do, she finds, based on analysis of Fragile Families and Child Wellbeing Study data.

An additional job may cover basic expenses but also compounds the burden that women with incarcerated partners already shoulder, she points out.

“Staying in touch and supporting an inmate—responding to his requests for food, clothing and books, preparing packages to the correctional institution’s specifications, coordinating family member visits, and keeping up with legal cases and appeals—can feel like a second job in and of itself,” explains Bruns.

Mothers with partners who are incarcerated usually have sole responsibility for children who may be “struggling with the absence of their fathers,” according to Bruns. Holding multiple jobs is also a known stressor that could raise mothers’ risk of stress-related health conditions.

Low-skilled women are often stuck in low-wage, dead-end jobs that can barely pay the bills, she asserts.

“Balancing multiple work roles in addition to family member incarceration may keep women from going to school or participating in other activities that improve their socioeconomic standing over the long-term,” writes Bruns.

Youth With a Parent in Prison Face More Trauma and Adversity

Youth ages 11 to 17 who experience the incarceration of a parent are more likely to have behavioral problems or mental health issues than their counterparts whose parents have never been jailed, Samantha J. Boch, Barbara L. Warren, and Jodi L. Ford of Ohio State University show.4

The team finds that household poverty plays a role, as does the number of traumatic events the young person has experienced, including homelessness, eviction, foster care, and serious injury or death in the family. Overall, they find that youth who deal with the incarceration of a parent experience three times as many adverse childhood experiences (ACEs) as their unaffected peers.

The researchers base their analysis on interviews with more than 600 parents or other caregivers participating in the Adolescent Development in Context study, a representative sample of Columbus, Ohio, and its surrounding suburbs.

The behavioral problems and mental health issues exhibited more frequently in children who experience a parent’s incarceration include poor attention, excessive anxiety, and externalizing behaviors such as rule breaking, temper outbursts, and property destruction, the analysis finds.

The researchers examined a wide-ranging set of 30 ACEs that includes aspects of financial distress and household churning or instability such as changes in household composition (for example, when a parent or parent’s new partner leaves or joins the household or when a child goes to live with grandparents) and residential moves.

“Well-documented research investigating the cumulative effect of ACEs indicates that youth exposed to parental incarceration may have a much greater likelihood for engaging in maladaptive coping behaviors (such as cigarette, alcohol, and illicit drug use, or violent delinquent behaviors) and experiencing depression, anxiety and post-traumatic stress disorder across the lifespan,” the researchers report.

They argue that mental health providers should view a parent’s incarceration as an important consideration of the child’s and family’s well-being that warrants continued observation, support, and follow-up. More research is needed to determine the best ways to screen and identify these youths using non-stigmatizing approaches that build on their strengths, they suggest. 

A Parent’s Incarceration Can Shape a Child’s Identity and Influence Anti-Social Behavior

Among young adults with an incarcerated parent, those who had a high need for parental approval were more likely to identify themselves as a troublemaker or partier during young adulthood than those who were emotionally independent, a recent study finds.5

Self-identities influence behavior, including criminal activity, making understanding the precursors of self-identity important to interventions designed to improve the life prospects of children with incarcerated parents, according to the researchers Jessica G. Finkeldey of the State University of New York at Fredonia, and Monica A. Longmore, Peggy C. Giordano, and Wendy D. Manning of Bowling Green State University.

The team examined publicly available incarceration records and analyzed data from the Toledo Adolescent Relationships Study, a regional survey of more than 900 men and women ages 18 to 28 interviewed five times between 2001 and 2011.

Developing “high emotional independence, or values, beliefs, and identities in contrast to and separate from an incarcerated parent,” may set young adults on a path shaped by different choices than those made by their incarcerated parent, the researchers suggest.

“It is possible that exposing children of incarcerated parents to positive role models and mentors, such as through mentorship programs, might help to reduce the transmission of antisocial identities and behaviors and should be investigated,” says Finkeldey.

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded population dynamics research centers was highlighted in this article: University of Washington, University of Michigan, Ohio State University, Bowling Green State University, and University of Texas at Austin.



  1. Bryan L. Sykes and Becky Pettit, “Measuring the Exposure of Parents and Children to Incarceration,” in Handbook on Children with Incarcerated Parents, ed. J. Mark Eddy and J. Poehlmann-Tynan, (Geneva: Springer, 2019): 11-23.
  2. Christine Leibbrand et al. “Barring Progress: The Influence of Parental Incarceration on Families’ Neighborhood Attainment,” Social Science Research 84 (2019): 102321
  3. Angela Bruns, “The Third Shift: Multiple Job Holding and the Incarceration of Women’s Partners,” Social Science Research 80 (2019): 202-15.
  4. Samantha J. Boch, Barbara L. Warren, and Jodi L. Ford, “Attention, Externalizing, and Internalizing Problems of Youth Exposed to Parental Incarceration,” Issues in Mental Health Nursing 40, no. 6 (2019): 466-75.
  5. Jessica G. Finkeldey et al. “Identifying as a Troublemaker/Partier: The Influence of Parental Incarceration and Emotional Independence,” Journal of Child and Family Studies 29, no. 3 (2020): 802-16.
Untidy Kitchen slow motion.

Married Women With Children and Male Partners Do More Housework Than Single Moms

Women with children and a heterosexual male partner do the most housework—more even than single moms, according to an analysis of time-use data.1

Specifically, married and cohabiting mothers report more housework than never-married or divorced/separated mothers, but all mothers report about the same amount of child-care time, find Joanna Pepin of the University of Texas at Austin, Liana Sayer of the University of Maryland, and Lynne Casper of the University of Southern California (see table).

TABLE: Mothers With a Male Partner Do More Housework,
Sleep Less Than Single Mothers

Predicted Minutes of Mother’s Time in Activities, by Marital Status
  Married Cohabiting Never Married Divorced / Separated
Childcare 120 115 119 118
Housework 171 165 138 145
Leisure 209 243 219 201
Sleep 513 513 527 520

Note: Based on American Time Use Surveys (2003-2012). Model controls for extended family member, number of children, children under two years old, children ages two to five, education, employment, race, age, and weekend diary day.

Source: Joanna R. Pepin, Liana C. Sayer, and Lynne M. Casper, “Marital Status and Mothers’ Time Use: Childcare, Housework, Leisure, and Sleep,” Demography 55, no. 1 (2018): 107-33.

For the study, they examined 24-hour time-use diaries from participants in the nationally representative American Time Use Survey (ATUS) between 2003 to 2012; they focused on white, black, and Hispanic mothers ages 18 to 54 with at least one child under age 13 living with them. Their analysis takes into account weekday and weekend schedules, and other differences such as employment, education, age of children, and the presence of other extended family members in the household.

Married Mothers Sacrifice Sleep and Leisure

After adjusting for other factors, married mothers did significantly more housework and slept less than never-married and divorced mothers, which runs counter to the notion that single mothers are time poor because they lack a partner to help with household chores and work for pay, Pepin notes.

The findings show the trade-offs mothers make in the face of limited time. All mothers protected their time with their children, doing roughly the same amount of child care once other factors are controlled. But married mothers did more housework at the expense of their own leisure and sleep, while nonpartnered mothers tended to do less housework and sleep somewhat more, the researchers find.

Cohabiting mothers spent about the same amount of time doing housework and sleeping as married mothers, but cohabiting mothers reported more leisure time. The differences in leisure time between married and cohabiting mothers may reflect differences in work hours, work schedules, or commuting times, but more research is needed to clarify the reason.

Married women may feel that to be a good wife, they must prioritize housework and child care ahead of their own leisure and sleep.

Social Expectations Shape Women’s Time

The data show that women with a male partner in the home put more time into housework, such as home-cooked meals—work that is symbolic of women’s feminine roles. “Being in a partnership appears to ratchet up the demands or expectations for housework,” Pepin points out.

Married women may feel that to be a good wife, they must prioritize housework and child care ahead of their own leisure and sleep, Pepin suggests. In other research, women have told interviewers that they feel social pressure to provide home-cooked meals, clean clothes, and a well-kept house; these expectations appear to be closely tied to contemporary definitions of appropriate behavior for wives and mothers.

Mothers’ Quality and Quantity of Leisure Time Differ

While never-married and cohabiting mothers reported more leisure time than married and divorced/separated mothers, they were more likely to spend it in sedentary activities, such as watching television, usually alone. Pepin notes this time-use pattern may be partially explained by physically demanding jobs, although more research is needed to be certain. By contrast, married mothers were slightly more likely to report leisure activities that were social and active, such as going out with friends or exercising.

Work Schedules Challenge the Traditional Household Division of Labor

Another study using ATUS time-diary data examined time spent on various types of housework in U.S. heterosexual married-couple families with children.2 Regardless of whether or not they are employed outside the home, women tend to do more traditionally female housework tasks (interior cleaning, laundry, and meal preparation) and men do more traditionally male-typed housework tasks (home maintenance, yard work, and vehicle care).

However, work schedules and time constraints can contribute to nontraditional divisions of housework tasks between parents, report researchers Noelle Chesley of the University of Wisconsin–Milwaukee and Sarah Flood of University of Minnesota–Twin Cities.

They analyzed parents’ housework time and tasks, comparing breadwinner father/at-home mother couples with breadwinner mother/at-home father couples. They drew on ATUS time diary data for 2008 to 2012 from more than 4,500 participants; their analysis controlled for a variety of characteristics including age, education, race, unemployment, income, retirement, disability, and the number and ages of children in the household.

Cooking, Cleaning, and Laundry Comprise the Bulk of Housework Tasks

The way couples divide traditionally female household tasks drives the overall division of housework time because female-typed tasks tend to be done much more frequently (often daily) than male-typed tasks, they find.

Breadwinners spend less time doing housework tasks traditionally linked to their gender on work days. Housework time differences among breadwinner mothers and breadwinner fathers shrink as their daily work hours increase, suggesting that time availability plays a role in reducing gender differences in housework among parents in similar situations.

Women feel socially accountable for the appearance of the household.

“Our comparisons also suggest that at-home parents may do more gender nontraditional household tasks on days their spouses work,” they report.

In breadwinner mother/at-home father couples, differences in housework time depend on whether breadwinner mothers are at work on a given day. On their days off, breadwinner mothers do more housework than at-home fathers, spending as much time doing housework as at-home mothers. By contrast, at-home mothers appear to do more housework daily whether breadwinner fathers are at work or not.

“Among working parents, mothers and fathers likely feel different housework pressures,” the researchers suggest. “Women feel socially accountable for the appearance of the household.”

Earlier research shows that breadwinner mother/at-home father couples engage in a “domestic handoff” on breadwinner mothers’ days off, either as a way for mothers to feel in control or to give the at-home fathers a break, according to the researchers.

They find that breadwinner mother/at-home father couples are frequently economically disadvantaged. The arrangement is often an adaptation to male job loss or job instability rather than a choice made “out of a strong desire to fulfill gender egalitarian ideas.”

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded population research centers was highlighted in this article: University of Maryland, University of Minnesota, and University of Texas-Austin.



  1. Joanna R. Pepin, Liana C. Sayer, and Lynne M. Casper, “Marital Status and Mothers’ Time Use: Childcare, Housework, Leisure, and Sleep,” Demography 55, no. 1 (2018): 107-33.
  2. Noelle Chesley and Sarah Flood, “Signs of Change? At-Home and Breadwinner Parents’ Housework and Child-Care Time,” Journal of Marriage and the Family 79, no. 2 (2017): 511-34.
Women walking toward the camera.

Eliminating Smoking and Obesity Could Shrink U.S. Health Disparities, But Where People Live Matters Too

Smoking and obesity are the two leading causes of preventable death, disability, and chronic disease in the United States. New research shows that eliminating them could go a long way in reducing racial health gaps. But location also plays a key role in health disparities, with neighborhood setting and state-level policies shaping residents’ health, this new study and another suggest.1

“We know that, compared to white peers, black men and women enjoy fewer years of life expectancy and healthy life expectancy, which is the number of years individuals can expect to live without disability. Meanwhile, immigrant- and U.S.-born Hispanics live longer than U.S.-born whites, despite their ethnic minority and lower socioeconomic status,” says Michelle Frisco of Penn State University, who conducted the first study with her Penn State colleague Jennifer Van Hook and Robert Hummer of the University of North Carolina, Chapel Hill. Their research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The researchers wanted to explore how obesity and smoking contributed to these differences because both health problems are concentrated in some groups in ways that are likely to produce health disparities. For example, white men and women smoke more than Hispanic immigrants, and black women are more likely to be obese and have a tougher time quitting smoking than white women.

Eliminating Smoking and Obesity Would Reduce the Black-White Health Gap

The research team analyzed data on health and mortality from almost 20,000 U.S.-born white, black, Hispanic, and foreign-born Hispanic men and women from the National Health and Nutrition Examination Survey. They focused on life expectancy and years spent disability-free for each racial or ethnic group. They then simulated how many years each group could expect to live overall and disability-free if no one ever smoked or was obese. Their findings showed some striking reductions in group differences.

“The actual disparity in the life expectancy between white and black women in the U.S. is approximately two years,” Frisco reports. “When we simulated the elimination of smoking and obesity, that gap was reduced to three months. Nearly every significant group difference was reduced to the point that gaps between groups were no longer statistically significant.”

There was one exception: Foreign-born Hispanic men and women retained their nearly three-year life-expectancy advantage over white peers even when the simulation eliminated both obesity and smoking.

“Hispanic immigrants typically have a longer life expectancy than whites to begin with. Eliminating obesity and smoking did not change this,” says Frisco. Not only do Hispanic immigrants smoke less than their U.S.-born peers, they are more likely to eat diets healthier than the typical American diet and live in tight-knit communities with widespread social support. They are also less likely to have substance abuse disorders, according to the researchers. In addition, they report that Hispanics who migrate to the United States tend to be healthier than their counterparts who remain in their country of origin.

Not Just Individual Behavior—Neighborhood Setting Shapes Health

The findings suggest that interventions aimed at preventing obesity and weight gain, reducing smoking, and increasing smoking cessation could be more effective if they’re tailored to specific populations. However, the researchers noted that these programs shouldn’t blame the victim by focusing only on individual behavior.

“We know that the places where people live influence smoking and obesity. For example, segregation leads U.S. black men and women to have elevated risks of long-term smoking and obesity in part because of the ways that tobacco companies disproportionately target minority neighborhoods, as do fast food restaurants and corporations who sell soda. These and other forms of structural racism must be addressed if we want to ensure greater health equity in the U.S.,” Frisco says.

The Disproportionate Health Consequences of State Policies

Some states invest more heavily in the health and well-being of their people, and these investments have “disproportionate consequences” for people with low education and income levels, Mark Hayward of the University of Texas at Austin, Jennifer Montez of Syracuse University, and Anna Zajacova of Western University show in the second study.

American adults with less education tend to report more chronic diseases and disabilities, and die sooner than those with more education, and these disparities have widened in recent decades, according to Hayward.

While more-educated people usually have higher incomes and less physically demanding jobs than less-educated people, the dynamics are more complicated than that, he explains. Blaming lifestyle differences between the two groups neglects the economic and social contexts where people live, he says.


A college education acts as a ‘personal firewall,’ protecting a person wherever they live.


The research team analyzed state-level health data on U.S-born adults ages 45 to 89 in two nationally representative data sets—the National Longitudinal Mortality Study and the American Community Survey. They focused on seven health measures including various functional difficulties, and problems with mobility, vision, hearing, and cognition, as well as overall self-reported health.

They found that the health gap between more- and less-educated people varies widely among states. The size of that gap is mainly related to the health levels of adults with less education.

A college education acts as a “personal firewall,” protecting a person wherever they live, Hayward suggests. “Well-educated persons have better access and support for healthy lifestyles and care, good jobs and rewards, and valuable networks and relationships, and they have sophisticated cognitive skills and a greater sense of control and human agency,” he says. By contrast, less-educated people are more vulnerable to differences in state policies and programs “precisely because they have fewer personal resources and are exposed to greater risks.”

The researchers point to Massachusetts and Mississippi to illustrate the wide differences in state-related policies affecting health. Unlike Massachusetts, Mississippi does not supplement the Earned Income Tax Credit that benefits working poor families, did not expand state Medicaid coverage following the 2010 Affordable Care Act, and has limited cigarette sales taxes.

Policies among the 50 U.S. states began to diverge in the 1970s with devolution—national policy changes that allowed states to opt out of federal programs and gave them more discretion over the services they offered.

Cigarette Taxes Influence Who Smokes

Hayward and colleagues explore excise taxes on cigarettes as an example of state-level policy differences that drive health disparities. Previous research has shown that tobacco control policies such as cigarette excise taxes shape smoking behavior.2

Hayward and colleagues find that smoking prevalence differs widely by state among less-educated people but is similar among those with higher levels of education. They show that state cigarette tax levels influence the prevalence of smoking among less-educated people but have a limited effect on their more-educated peers. Less-educated people tend to smoke less if cigarette taxes are high, while more-educated people have more resources and experience other incentives and disincentives to smoking, they suggest.

The five states with the largest increases in cigarette excise taxes between 1990 and 2014 saw smoking prevalence differences between less- and more-educated adults shrink by two-thirds—from an 11.2 percentage-point gap to a 3.8 percentage-point gap. But the gap nearly doubled in the five states with the smallest increases in state cigarette excise taxes, from a difference of 8.4 percentage points to 16.1 percentage points.

How Can We Close the Health Gap?

The adverse health effects of low education levels are much less evident in states with strong social safety nets and policies that encourage investments in residents’ health and well-being, Hayward reports. “These types of state policies and contextual factors can compensate for the effects of low education on health.”

When social safety nets are weak and investment in the well-being of their populations is low, states can exacerbate the health effects of low education, he suggests.

“States have become a major institutional force affecting incentives and capacities of residents to create healthy lives,” he says. This study on cigarette taxes and health is part of a growing body of research on the impact of state policy differences on health. Earlier studies by Hayward and colleagues show that state policies contribute to state-level differences in premature deaths and disability, particularly among less-educated women.3

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded population dynamics research centers was highlighted in this article: Penn State University, University of North Carolina at Chapel Hill, and University of Texas at Austin.



  1. Michelle L. Frisco, Jennifer Van Hook, and Robert A. Hummer, “Would the Elimination of Obesity and Smoking Reduce U.S. Racial/Ethnic/Nativity Disparities in Total and Healthy Life Expectancy?” SSM Population Health 7, no. 1 (2019); and Jennifer Karas Montez, Mark D. Hayward, and Anna Zajacova, “Educational Disparities in Adult Health: U.S. States as Institutional Actors on the Association,” Socius 5, no. 1 (2019): 1-14.
  2. Chloe E. Bird and Patricia P. Rieker, Gender and Health: The Effects of Constrained Choices and Social Policies (New York, Cambridge University Press: 2018).
  3. Mark D. Hayward, Robert A. Hummer, and Isaac Sasson, “Trends and Group Differences in the Association Between Educational Attainment and U.S. Adult Mortality: Implications for Understanding Education’s Causal Influence,” Social Science and Medicine 127, no. 1 (2015): 8-18; Jennifer Karas Montez, Anna Zajacova, and Mark D. Hayward, “Explaining Inequalities in Women’s Mortality Between U.S. States,” SSMPopulation Health 2, no. 1 (2016): 561-71; Jennifer Karas Montez, Anna Zajacova, and Mark D. Hayward, “Disparities in Disability by Educational Attainment Across U.S. States,” American Journal of Public Health 107, no. 1 (2017): 1101-8; Jennifer Karas Montez, Mark D. Hayward, and Douglas A. Wolf, “Do U.S. States’ Socioeconomic and Policy Contexts Shape Adult Disability?” Social Science and Medicine 178, no. 1 (2017): 115-26; and Jennifer Karas Montez, “Deregulation, Devolution, and State Preemption Laws’ Impact on U.S. Mortality Trends,” American Journal of Public Health 107, no. 1 (2017): 1749-50.