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Education is among the strongest socioeconomic predictors of health and mortality. However, the social nature of the relationship of education and health is rarely taken into account. The first chapter of the dissertation looks into how macrosocial context can influence this association. I investigate the changes in the educational gradient in health in Russia in the 2000s using two waves of WHO SAGE survey to show some suggestive evidence that the educational gradients are narrowing following the socioeconomic changes in Russia during the decade, at least for some measures of health. Household and family level social structure is also a significant explanatory factor that mediates the association of education and health. In the second chapter, I use data from the 11 waves of HRS to show that spousal education is an important factor in predicting health outcomes net of one's own education. In particular, I demonstrate how health benefits of having an educated wife appear to accumulate over time, while health benefits of an educated husband are more closely related to contemporaneous measures. Additionally, I observe that the effects of spousal education on mortality and self-rated health are manifested differently. The association between education and self-rated health is present even when mediating variables are controlled for, while the effect becomes insignificant for mortality measures. Finally, the third chapter shows how family level social characteristics (namely, spousal education) can interact with macro level social structure (country context) in forming health outcomes. I use data from 18 countries collected using comparable methodologies (HRS sister studies harmonized by the Global Gateway to Aging project). The results show that welfare regimes in the countries have some predictive power for explaining educational gradients in health, and more egalitarian countries do show less steep gradients. Importantly, however, country-specific context is a stronger predictor of the effects of spousal education on women's health. Men, on the other hand, benefit more similarly from the higher educational attainment of their wives in different countries.
Originally published by Bradbury Press in 1973.
This dissertation consists of three essays, each on one emerging public health issue that calls for new policy making. The first essay studies 15,000 adult individuals from a longitudinal dataset, the China Health and Nutrition Survey, collected in China 1991-2006. It explores the effects of food prices on obesity and shows evidence that while obesity corresponds to food prices changes, the effects might not always be accurately captured by Body Mass Index (BMI), but by a more direct measure of body fat - triceps skinfold thickness (TSF). The second essay extends the first essay and focuses on health implications of obesity on outcomes such as hypertension and diabetes. The sample is limited to non-obese individuals with a BMI less than 28. TSF, as a proxy for body fat, is shown to have significant independent effects on health. The third essay looks at unintended consequences of a new drug innovation, Viagra, and its successors, Cialis, and Levitra. It finds that erectile dysfunction (ED) medication users have a higher rate of STDs. Because most ED drug consumers are 40+ males, who are above the typical age range where routine STD tests are recommended, this finding reveals a new health threat to older populations and potentially the general public as a whole.
This dissertation consists of three essays that are motivated by an aging world. Its primary goals are to (a) identify how older adult health and its correlates--with a particular focus on social engagement--systematically differ by residential context; and (b) consider the implications of subjective health changes across older ages. The first chapter explores how the type and intensity of older-adult social participation varies by county-level population density. Using the 2003 and 2011 waves of the Wisconsin Longitudinal Study (n=3,006), I find that older adults living in rural counties with relatively low population densities are less socially active than their counterparts in higher-density counties. I also find that just five (of twelve) social activities are related to better health; while only three are associated with health change. Chapter two examines relationships between older adult health and living in relatively older and younger municipalities. Using a national sample of almost 5,000 Japanese older adults over two decades, I employ growth curve models to estimate how self-rated health and self-rated health trajectories differs by local area age structure. I find older adults living in the "oldest places" of Japan are more likely to report less than good health, when compared to those living in younger areas. In addition, relatively high levels of social engagement among older adults living in oldest areas help mitigate even greater odds of reporting worse health in these places. Chapter three explores how two measures of self-rated health (SRH) change are related to mortality. Data come from the Asset and Health Dynamics survey--the "oldest-old" portion of the Health and Retirement Study--and follow 6,233 individuals over thirteen years. After controlling for morbidity, individual characteristics, and SRH, those who changed SRH categories between survey waves and those who retrospectively reported an improvement in health continue to have a greater risk of death; when compared to those with no change. These findings suggest that the well-established associations between SRH status and mortdality may understate the risk of death for oldest-old individuals with recent subjective health improvements.