@article {11777, title = {Dynamics of Financial Hardship in the United States: Health and Retirement Study 2006-2016.}, journal = {Journal of Gerontological Social Work}, volume = {65}, year = {2022}, pages = {241-251}, abstract = {

The purpose of this study was to examine the temporal trends and dynamics of financial hardship among older adults in the U.S. between 2006 and 2016 using the Health and Retirement Study. Sample included a total of 13,537 eligible person observations with a median age of 68~years. Financial hardship included measures of difficulty paying bills, food insecurity, taking less medication due to cost, and ongoing financial strain. Regression analyses were performed using a three-wave quadrennial model to estimate the prevalence of financial hardship over time, to explore temporal patterns and identify persistent hardship. Findings reveal that 51\% of respondents who experienced food insecurity at one or more waves were transient. This pattern was similar to respondents who experienced ongoing financial strain (52\% transient). Respondents who reported difficulty paying bills (68\%) and reduced medications due to cost (62\%) were also transient. Significant predictors across all four domains of financial hardship include age, years of education, marital status, self-rated health. Being African American was positively associated with reduced medication use and food insecurity. This study provides insight into the temporal dynamics of financial hardship in later life. It also highlights the contiguous, intermediate and transient nature of financial hardship among older adult populations.

}, keywords = {Financial hardship, Older Adults, Poverty, temporal trends}, issn = {1540-4048}, doi = {10.1080/01634372.2021.1953662}, author = {Gillian L Marshall and Bayaz-Ozturk, Gulgun and Eva Kahana and William T Gallo and Seghal, Ashwini} } @article {10529, title = {The contribution of dementia to the disparity in family wealth between black and non-black Americans}, journal = {Ageing and Society}, volume = {40}, year = {2020}, pages = {306-327}, abstract = {{The enormous economic burden of dementia in the United States of America falls disproportionately on families coping with this devastating disease. Black Americans, who are at greater risk of developing dementia than white Americans, hold on average less than one-eighth of the wealth of white Americans. This study explores whether dementia exacerbates this wealth disparity by examining dementia{\textquoteright}s effect on wealth trajectories of black versus non-black Americans over an eight-year period preceding death, using five waves of data (beginning in 2002 or 2004) on decedents in the 2012 and 2014 waves of the Health and Retirement Study (N = 2,429). Dementia is associated with a loss of 97 per cent of wealth among black Americans, compared with 42 per cent among non-black Americans, while wealth loss among black and non-black Americans without dementia did not differ substantially (15\% versus 19\%). Dementia appears to increase the probability of wealth exhaustion among both black and non-black Americans, although the estimate is no longer significant after adjusting for all covariates (for blacks, odds ratio (OR) = 2.04, 95\% confidence interval (CI) = 0.83, 5.00; for non-blacks}, keywords = {African Americans, Age, Aging, Alzheimer{\textquoteright}s disease, Alzheimers disease, Blacks, Costs, Dementia, dementia cost, Equity, Families \& family life, Gerontology And Geriatrics, Health and Retirement Study, Income inequality, Long term health care, Ownership, Racial differences, Racial Disparities, Retirement, Senility, Studies, United States{\textendash}US, Wealth, wealth disparities}, isbn = {0144686X}, doi = {10.1017/S0144686X18000934}, author = {Jennifer Kaufman and William T Gallo and Fahs,Marianne C.} } @article {10787, title = {The price of mental well-being in later life: the role of financial hardship and debt}, journal = {Aging \& Mental Health}, year = {2020}, note = {PMID: 32426995}, pages = {1-7}, abstract = {Objective: This study investigated the associations between various financial hardship and debt indicators and mental health status among older adults. Methods: Using data from the Health and Retirement Study (HRS), we considered the association between different forms of financial hardship and debt of those who were identified as having high levels of depressive symptoms (N = 7678) and anxiety (N = 8079). Financial hardship indicators: difficulty paying bills, food insecurity, and medication need; debt indicators: credit card and medical debt. Associations were tested using multiple logistic regression analyses and are reported as relative risk (RR) ratios and 95\% confidence intervals (CIs). Results: Participants who had difficulty paying bills were more likely to have high levels of depressive symptoms (RR = 2.06, CI = 1.75{\textendash}2.42, p < 0.001) and anxiety (RR = 1.46, CI = 1.02{\textendash}2.05, p < 0.001) compared to those who did not have financial difficulty. Similarly, medical debt was associated with depressive symptoms (RR = 1.43, CI = 1.14{\textendash}1.74, p < 0.01) and anxiety (RR = 1.20, CI = 0.96{\textendash}1.50, p < 0.01). Credit card debt was not significantly associated with either mental health outcome. Conclusion: Indicators of financial hardship and medical debt were associated with depressive symptoms and anxiety in a cohort of older adults. In contrast, the influence of credit card debt appeared to be more complex and vary by individual. These findings indicate that doing without meeting personal salient needs has a particularly adverse effect on psychological well-being.}, keywords = {Anxiety, Debt, depression, Financial hardship, Mental Health}, doi = {10.1080/13607863.2020.1758902}, author = {Gillian L Marshall and Eva Kahana and William T Gallo and Kim L. Stansbury and Stephen M Thielke} } @article {9489, title = {Depression Associated With Transitions Into and Out of Spousal Caregiving}, journal = {The International Journal of Aging and Human Development}, volume = {88}, year = {2019}, type = {Journal}, abstract = {This study investigates depressive symptoms among spousal caregivers in three groups: those who become caregivers, those who continue care, and those who exit caregiving, compared with those who remain non-caregivers. We also examine depressive symptoms among widowed caregivers by length of bereavement. We use four waves of the U.S. Health and Retirement Study (2006, 2008, 2010, and 2012), for a total of 43,262 observations. Findings show elevated levels of depressive symptoms for new caregivers, continuing caregivers, and exit caregivers. Among exit caregivers, symptoms were elevated when measured in the first 15 months after the spouse{\textquoteright}s death but declined thereafter. These findings add to the evidence that spousal caregiving carries a risk for depression, and symptoms are likely to peak near the end of the caregiving episode. These results underscore the need to provide support to newly widowed individuals.}, keywords = {Caregiving, Couples, Depressive symptoms, Transitions}, issn = {0091-4150}, doi = {10.1177/0091415018754310}, url = {https://journals.sagepub.com/doi/10.1177/0091415018754310}, author = {Jay S Kaufman and Lee, Yeonjung and Vaughon, Wendy and Unuigbe, Aig and William T Gallo} } @article {9414, title = {Differential Changes in Health Measures by Caregiving Status: Hierarchical Models}, journal = {Work, Aging and Retirement}, volume = {3}, year = {2017}, pages = {393-402}, abstract = {The purpose of this study is to compare the health trajectories/trends of caregivers and non-caregivers before and after the caregivers begin to provide informal services. In this case we focus on caregiving services provided to parents/parents-in-law. The study uses a sample of N = 19,943 observations (drawn from 1,813 unique individuals) observed over 11 waves of the Health and Retirement Study. Using Hierarchical Linear Model (HLM) Methods, the trajectories of health outcomes for caregivers are compared to those of non-caregivers. We examined trajectories related to general health, measures of mobility, motor skills, cognition and measures of depression. We control for education, wealth, occupation, gender, marital status, and race. For caregivers, there is a 0.027 (0.014 per year) increase in the mobility difficulty index and a 0.020 (0.010 per year) increase in large muscle movement difficulty index for every year after the commencement of caregiving, compared to non-caregivers. There is also a significant 0.7 percentage point increase in the probability of reporting a stroke and a 0.118 (0.059 per year) drop in the cognition summary score for each additional year after the start of caregiving. These findings provide evidence of the adverse health effects of caregiving on its providers, particularly with regard to the physical and mental well-being of caregivers.}, keywords = {Caregiving, Health Trajectories}, issn = {2054-4642}, doi = {10.1093/workar/wax005}, url = {http://academic.oup.com/workar/article/3/4/393/3101301/Differential-Changes-in-Health-Measures-byhttp://academic.oup.com/workar/article-pdf/3/4/393/19644858/wax005.pdf}, author = {Unuigbe, Aig and Lee, Yeonjung and Vaughon, Wendy and Jennifer Kaufman and William T Gallo} } @article {8396, title = {Mechanisms of the Effect of Involuntary Retirement on Older Adults Self-Rated Health and Mental Health}, journal = {Journal of Gerontological Social Work}, volume = {59}, year = {2016}, pages = {35-55}, publisher = {59}, abstract = {This study examined mechanisms of the effect of involuntary retirement on self-rated health and mental health among adults aged 50 or older. Using two waves of the Health and Retirement Study (2006 and 2010), we selected a sample of 1,195 individuals working for pay at baseline who responded to a lifestyle questionnaire in both waves. Regression-based path analyses were conducted to test the mediating effects of financial control, positive and negative family relationships, and social integration on the relationship between involuntary retirement and self-rated health and mental health. Results of mediation analyses indicated that transition to involuntary retirement was directly negatively associated with subsequent self-rated health and indirectly negatively associated with mental health via perception of less financial control. Voluntary retirement was indirectly positively associated with both self-rated and mental health via perception of more financial control. No significant direct or indirect effects of retirement were found when retirement was measured with an aggregate measure without specifying its voluntariness. Findings emphasize the importance of specifying the voluntariness of retirement and recognizing the heterogeneity in the mechanisms of involuntary and voluntary retirement.}, keywords = {Health Conditions and Status, Retirement Planning and Satisfaction}, doi = {10.1080/01634372.2015.1128504}, url = {http://dx.doi.org/10.1080/01634372.2015.1128504}, author = {Min-Kyoung Rhee and Mich{\`a}lle E. Mor Barak and William T Gallo} } @article {8023, title = {The effect of retirement on alcohol consumption: results from the US Health and Retirement Study}, journal = {The European Journal of Public Health}, volume = {24}, year = {2014}, pages = {485-489}, publisher = {24}, abstract = {Background: Prior research examining the association between retirement and alcohol consumption is inconsistent with respect to salience, direction and magnitude. Reasonable conceptual arguments for both positive (e.g. coping, introduction of leisure time) and negative (e.g. severance of work-related social relationships) changes further complicate investigations of this critical association, as do differences in study design, national setting and measurement of alcohol use. Methods: This prospective longitudinal study analyses 2-year wave-pairs drawn from seven waves (14 years) of data from the US Health and Retirement Study to assess the effect of complete retirement on weekly alcohol consumption (n = 9979 observations; 4674 unique participants). We use multiple regression analysis in a two-period follow-up design and account for potential selection bias and reverse causality not addressed in prior research on this topic. Results: We find that retirement is positively associated with subsequent weekly alcohol consumption for men who reported drinking at both follow-up and the prior study wave ( = 1.9, 95 confidence interval = 0.43 3.36). No association was observed among women. Conclusion: Our results suggest that health care professionals should monitor the drinking habits of retired men, as older individuals are particularly susceptible to the adverse effects of heavy alcohol use.}, keywords = {Health Conditions and Status, Retirement Planning and Satisfaction}, doi = {10.1093/eurpub/cku027}, url = {http://eurpub.oxfordjournals.org/content/early/2014/03/17/eurpub.cku027.abstract}, author = {Wang, Xu and Steier, Jessica B. and William T Gallo} } @article {unknown, title = {Effect of Job Loss on Wealth Accumulation of Older Workers}, year = {2013}, institution = {CUNY School of Public Health at Hunter College}, abstract = {In this study, we examine the impact of job displacement on wealth holdings of older workers. Using data from the Health and Retirement Study, we measure the impact of job loss on the total wealth and its subcomponents. We find that a typical worker experiences a persistent reduction in his/her wealth balances at a rate of 8 percent six or more years post job loss. Wealth shocks of this magnitude during the years leading up to retirement may jeopardize wealth adequacy during retirement. In our assessment of wealth adequacy, we find that job displacement can push more people into {\textquotedblleft}near poverty{\textquotedblright}. We use the formulation of Love et al. (2007) to compare household wealth to poverty by computing the ratio of household wealth to the actuarial present value of poverty lines. We find that 11.1 percent of the displaced survey respondents have poverty ratio between 1 and 1.5 as opposed to 7.8 percent of the not displaced survey respondents. }, keywords = {Job loss, Labor demand, Labor Dynamics, wealth accumulation, Work}, url = {https://www.researchgate.net/publication/320626773_Effect_of_Job_Loss_on_Wealth_Accumulation_of_Older_Workers}, author = {Bayaz Ozturk, Gulgun and William T Gallo} } @article {7917, title = {Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals.}, journal = {Health Econ}, volume = {22}, year = {2013}, month = {2013 Jan}, pages = {89-105}, publisher = {22}, abstract = {

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.

}, keywords = {Adult, Aged, Aged, 80 and over, Alcohol Drinking, Alcoholic Beverages, Behavior, Body Height, Costs and Cost Analysis, Female, Health Status, Humans, Male, Middle Aged, Models, Econometric, Socioeconomic factors, Taxes, United States}, issn = {1099-1050}, doi = {10.1002/hec.1817}, author = {Padmaja Ayyagari and Deb, Partha and Jason M. Fletcher and William T Gallo and Jody L Sindelar} } @article {7556, title = {The effect of job loss on overweight and drinking.}, journal = {J Health Econ}, volume = {30}, year = {2011}, month = {2011 Mar}, pages = {317-27}, publisher = {30}, abstract = {

This paper examines the impact of job loss due to business closings on body mass index (BMI) and alcohol consumption. We suggest that the ambiguous findings in the extant literature may be due in part to unobserved heterogeneity in response and in part due to an overly broad measure of job loss that is partially endogenous (e.g., layoffs). We improve upon this literature using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data from the Health and Retirement Study. For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. These results suggest the health effects of job loss could be concentrated among "at risk" individuals and could lead to negative outcomes for the individuals, their families, and society at large.

}, keywords = {Alcohol Drinking, Body Mass Index, Female, Humans, Longitudinal Studies, Male, Middle Aged, Overweight, Unemployment, United States}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2010.12.009}, author = {Deb, Partha and William T Gallo and Padmaja Ayyagari and Jason M. Fletcher and Jody L Sindelar} } @article {7546, title = {Job loss and depression: the role of subjective expectations.}, journal = {Soc Sci Med}, volume = {72}, year = {2011}, month = {2011 Feb}, pages = {576-83}, publisher = {72}, abstract = {

Although the importance of expectations is well documented in the decision-making literature, a key shortcoming of the empirical research into effects of involuntary job loss on depression is perhaps its neglect of the subjective expectations of job loss. Using data from the US Health and Retirement Study surveys we examine whether the impact of job loss on mental health is influenced by an individual{\textquoteright}s subjective expectations regarding future displacement. Our results imply that, among older workers in the age range of 55-65 year, subjective expectations are as significant predictors of depression as job loss itself, and ignoring them can bias the estimate of the impact of job loss on mental health.

}, keywords = {Adaptation, Psychological, Aged, Bias, depression, Empirical Research, Health Surveys, Humans, Mental Health, Middle Aged, Stress, Psychological, Unemployment, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2010.11.014}, author = {Mandal, Bidisha and Padmaja Ayyagari and William T Gallo} } @article {7412, title = {Differential Impact of Involuntary Job Loss on Physical Disability Among Older Workers Does Predisposition Matter?}, journal = {Res Aging}, volume = {31}, year = {2009}, month = {2009 May 01}, pages = {345-360}, publisher = {31}, abstract = {

Older workers{\textquoteright} share of involuntary job losses in the United States has grown fairly consistently in recent decades, prompting greater interest in the health consequences of involuntary unemployment among individuals nearing retirement. In this study, the authors applied the multifactorial model of geriatric health to investigate whether late-career involuntary job loss was associated with subsequent physical disability and whether the effect of involuntary job loss on physical disability varied by predisposition. Using data from the first four waves (1992 to 1998) of the Health and Retirement Survey, the authors measured predisposition with individual risk factors for functional disability and indices of aggregate risk. The results of gender-specific models fit with generalized estimating equations revealed that unmarried women and those with low predisplacement incomes had heightened risk for subsequent functional disability. No differential effects of job loss were found for men.

}, issn = {1552-7573}, doi = {10.1177/0164027508330722}, author = {William T Gallo and Jennie E Brand and Teng, Hsun-Mei and Leo-Summers, Linda and Amy L. Byers} } @article {7293, title = {The impact of occupation on self-rated health: cross-sectional and longitudinal evidence from the health and retirement survey.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, note = {PMID 19196689}, month = {2009 Jan}, pages = {118-24}, publisher = {64}, abstract = {

BACKGROUND: The objective of this study is to estimate occupational differences in self-rated health, both in cross-section and over time, among older individuals.

METHODS: We use hierarchical linear models to estimate self-reported health as a function of 8 occupational categories and key covariates. We examine self-reported health status over 7 waves (12 years) of the Health and Retirement Study. Our study sample includes 9,586 individuals with 55,389 observations. Longest occupation is used to measure the cumulative impact of occupation, address the potential for reverse causality, and allow the inclusion of all older individuals, including those no longer working.

RESULTS: Significant baseline differences in self-reported health by occupation are found even after accounting for demographics, health habits, economic attributes, and employment characteristics. But contrary to our hypothesis, there is no support for significant differences in slopes of health trajectories even after accounting for dropout.

CONCLUSIONS: Our findings suggest that occupation-related differences found at baseline are durable and persist as individuals age.

}, keywords = {Aged, Attitude to Health, Cohort Studies, Cross-Sectional Studies, Educational Status, Female, Health Status Indicators, Health Surveys, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Mortality, Occupations, Odds Ratio, Retirement, Social Class, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbn006}, author = {Ralitza Gueorguieva and Jody L Sindelar and Tracy Falba and Jason M. Fletcher and Patricia S Keenan and Wu, Ran and William T Gallo} } @article {5747, title = {Job Loss: Eat, drink and try to be merry?}, number = {15122}, year = {2009}, institution = {The National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {This paper examines the impact of job loss from business closings on body mass index (BMI) and alcohol consumption. We improve upon extant literature by using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data (Health and Retirement Study). For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. Thus health effects of job loss could be concentrated among at risk individuals.}, keywords = {Employment and Labor Force, Health Conditions and Status}, doi = {10.3386/w15122}, author = {Deb, Partha and William T Gallo and Padmaja Ayyagari and Jason M. Fletcher and Jody L Sindelar} } @article {5765, title = {Sin Taxes: Do Heterogeneous Responses Undercut Their Value?}, number = {15124}, year = {2009}, institution = {The National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {This paper estimates the price elasticity of demand for alcohol using Health and Retirement Survey data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price but the other is unresponsive. Differences between these two groups can be explained in part by the behavioral factors of risk aversion, financial planning horizon, forward looking and locus of control. These results have policy implications. Only a subgroup responds significantly to price. Importantly, the unresponsive group drinks more heavily, suggesting that a higher price could fail to curb drinking by those most likely to cause negative externalities. In contrast, those least likely to impose costs on others are more responsive, thus suffering greater deadweight loss yet with less prevention of negative externalities.}, keywords = {Health Conditions and Status, Methodology, Public Policy}, doi = {10.3386/w15124}, author = {Padmaja Ayyagari and Deb, Partha and Jason M. Fletcher and William T Gallo and Jody L Sindelar} } @article {7399, title = {Work expectations, realizations, and depression in older workers.}, journal = {J Ment Health Policy Econ}, volume = {12}, year = {2009}, note = {Journal Article}, month = {2009 Dec}, pages = {175-86}, publisher = {12}, abstract = {

AIMS OF THE STUDY: In this study, we explore whether ex ante work expectations, conditional on work force status at age 62, affect self-reported depressive symptoms at age 62.

METHODS: Our sample includes 4,387 participants of the Health and Retirement Study, a national longitudinal survey of individuals born between 1931 and 1941, and their spouses. The sample is composed of workers who were less than 62 years of age at the study baseline (1992), and who had reached age 62 by the current study endpoint (2004). This sample enables comparison of realized work status with prior expectations. We estimate the impact of expected work status on self-reported depressive symptoms using negative binomial and logistic regression methods. Sex-stratified regressions are estimated according to full-time work status at age 62. The primary outcome is a summary measure of self-reported depressive symptoms based on a short form of the Center for Epidemiologic Studies-Depression (CES-D) scale. The explanatory variable of interest is the subjective probability of working full-time at the age of 62, reported by participants at the 1992 HRS baseline. We control for baseline socioeconomic and demographic variables as well as life events and changes in macroeconomic conditions that occur within the study timeframe.

RESULTS: Among participants who were not working full time at age 62, we find that men who provided a higher ex ante likelihood of full-time employment at 62 had significantly worse self-reported depressive symptoms than men who provided a lower ex ante likelihood. A similar effect was not found for women. Among participants who were working full time at age 62, we do not find a statistical relationship between ex ante expectations and age-62 self-reported depressive symptoms, for either men or women.

DISCUSSION: The results suggest that an earlier-than-anticipated work exit is detrimental to mental health for men nearing normal retirement age. Previous research has demonstrated that stress is a causal factor in depression, and a premature labor force departure, which is inconsistent with an individual{\textquoteright}s cognitive judgment of a suitably timed exit from work, is a psychologically stressful transition that could realistically induce depression. This may be especially true of men, who in this cohort, have stronger labor force attachment than women and tend to define their roles by their occupation. The advantages of the study include nationally representative data, a baseline depression control that circumscribes the effect of endogeneity, and a reasonably long follow-up. Despite our efforts to infer causality, unmeasured factors may account for part of the observed relationship. IMPLICATIONS FOR HEALTH POLICY AND RESEARCH: Depression is a disease that, if untreated, may have serious consequences for behavioral, medical, and social well-being. Our results suggest that further research should aim to estimate the magnitude of clinically severe and mild depression in populations of those who retire earlier than expected, especially for men. Such information could help health care planners and policy makers to direct resources to the mental health needs of men who retire prematurely.

}, keywords = {Age Factors, depression, Employment, Female, Health Behavior, Humans, Longitudinal Studies, Male, Middle Aged, Psychometrics, Retirement, Sex Factors, Stress, Psychological}, issn = {1091-4358}, url = {URL:http://www.icmpe.org/test1/journal/journal.htm Publisher{\textquoteright}sURL}, author = {Tracy Falba and Jody L Sindelar and William T Gallo} } @article {7129, title = {Use of preventive care by the working poor in the United States.}, journal = {Prev Med}, volume = {44}, year = {2007}, month = {2007 Mar}, pages = {254-9}, publisher = {44}, abstract = {

OBJECTIVE: Examine the association between poverty and preventive care use among older working adults.

METHOD: Cross-sectional analysis of the pooled 1996, 1998 and 2000 waves of the Health and Retirement Study, a nationally representative sample of older community-dwelling adults, studying self-reported use of cervical, breast, and prostate cancer screening, as well as serum cholesterol screening and influenza vaccination. Adults with incomes within 200\% of the federal poverty level were defined as poor.

RESULTS: Among 10,088 older working adults, overall preventive care use ranged from 38\% (influenza vaccination) to 76\% (breast cancer screening). In unadjusted analyses, the working poor were significantly less likely to receive preventive care. After adjustment for insurance coverage, education, and other socio-demographic characteristics, the working poor remained significantly less likely to receive breast cancer (RR 0.92, 95\% CI, 0.86-0.96), prostate cancer (RR 0.89, 95\% CI, 0.81-0.97), and cholesterol screening (RR 0.91, 95\% CI, 0.86-0.96) than the working non-poor, but were not significantly less likely to receive cervical cancer screening (RR 0.96, 95\% CI, 0.90-1.01) or influenza vaccination (RR 0.92, 95\% CI, 0.84-1.01).

CONCLUSION: The older working poor are at modestly increased risk for not receiving preventive care.

}, keywords = {Cost of Illness, Cross-Sectional Studies, Employment, Female, Health Promotion, Health Services Accessibility, Health Services Needs and Demand, Humans, Male, Mass Screening, Middle Aged, Patient Acceptance of Health Care, Poverty, Preventive Health Services, Risk Assessment, Socioeconomic factors, United States, Vulnerable Populations}, issn = {0091-7435}, doi = {10.1016/j.ypmed.2006.11.006}, author = {Joseph S. Ross and Bernheim, Susannah M. and Elizabeth H Bradley and Teng, Hsun-Mei and William T Gallo} } @article {7115, title = {The effect of recurrent involuntary job loss on the depressive symptoms of older US workers.}, journal = {Int Arch Occup Environ Health}, volume = {80}, year = {2006}, month = {2006 Nov}, pages = {109-16}, publisher = {80}, abstract = {

OBJECTIVES: The objective of this study was to assess whether recurrent involuntary job loss among US workers nearing retirement resulted in increasingly less severe changes in depressive symptoms with successive job losses.

METHODS: With data drawn from the US Health and Retirement Survey (HRS), we used repeated measures longitudinal analysis to investigate the effect of recurrent job loss on follow-up depressive symptoms, measured up to 2 years following job loss. Study participants include 617 individuals, aged 51-61 years at the 1992 study baseline, who had at least one job loss between 1990 and 2000. Our primary outcome variable was a continuous measure of depressive symptoms, constructed from the 8-item Center for Epidemiologic Studies-Depression (CES-D) battery administered at every HRS wave. A second, dichotomous outcome, derived from the continuous measure, measured clinically relevant depressive symptoms. The exposure (recurrent job loss) was defined by binary dummy variables representing two and three/four job losses. All job losses were the result of either plant closing or layoff.

RESULTS: Our main finding indicates that, after relevant covariates are controlled, compared to one job loss, two job losses result in a modest increase in the level depressive symptoms (not significant) at two-year follow-up. Three or more job losses result, on average, in a decline in depressive symptoms to a level near pre-displacement assessment (not significant). Somewhat in contrast, two job losses were found to be associated with increased risk of clinically relevant depressive symptoms.

CONCLUSIONS: The principal finding confirms our hypothesis that, among US workers nearing retirement, repeated exposure to job separation results in diminished effects on mental health. Adaptation to the job loss stressor may underlie the observed response, although other explanations, including macroeconomic developments, are possible.

}, keywords = {Adaptation, Physiological, depression, Employment, Female, Humans, Life Change Events, Longitudinal Studies, Male, Middle Aged, Retirement, Stress, Psychological, United States}, issn = {0340-0131}, doi = {10.1007/s00420-006-0108-5}, author = {William T Gallo and Elizabeth H Bradley and Teng, Hsun-Mei and Stanislav V Kasl} } @article {9743, title = {The impact of late career job loss on myocardial infarction and stroke: a 10 year follow up using the health and retirement survey}, journal = {Occupational and Environmental Medicine}, volume = {63}, year = {2006}, month = {Jun-06-2006}, pages = {683 - 687}, abstract = {Background: Involuntary job loss is a major life event associated with social, economic, behavioural, and health outcomes, for which older workers are at elevated risk. Objective: To assess the 10 year risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers over 50 years of age. Methods: Analysing data from the nationally representative US Health and Retirement Survey (HRS), Cox proportional hazards analysis was used to estimate whether workers who suffered involuntary job loss were at higher risk for subsequent MI and stroke than individuals who continued to work. The sample included 4301 individuals who were employed at the 1992 study baseline. Results: Over the 10 year study frame, 582 individuals (13.5\% of the sample) experienced involuntary job loss. After controlling for established predictors of the outcomes, displaced workers had a more than twofold increase in the risk of subsequent MI (hazard ratio (HR) = 2.48; 95\% confidence interval (CI) = 1.49 to 4.14) and stroke (HR = 2.43; 95\% CI = 1.18 to 4.98) relative to working persons. Conclusion: Results suggest that the true costs of late career unemployment exceed financial deprivation, and include substantial health consequences. Physicians who treat individuals who lose jobs as they near retirement should consider the loss of employment a potential risk factor for adverse vascular health changes. Policy makers and programme planners should also be aware of the risks of job loss, so that programmatic interventions can be designed and implemented to ease the multiple burdens of joblessness.}, keywords = {Economics, Job loss, Myocardial Infarction, Stroke, Unemployment}, issn = {1351-0711}, doi = {10.1136/oem.2006.026823}, url = {http://oem.bmj.com/cgi/doi/10.1136/oem.2006.026823https://syndication.highwire.org/content/doi/10.1136/oem.2006.026823}, author = {William T Gallo and Teng, H.M. and Tracy Falba and Stanislav V Kasl and Krumholz, H.V. and Elizabeth H Bradley} } @article {7099, title = {The Impact of Late-Career Job Loss on Myocardial Infarction and Stroke: A 10-year follow-up using the Health and Retirement Survey}, journal = {Occupational and Environmental Medicine}, volume = {63}, year = {2006}, pages = {683-7}, publisher = {63}, abstract = {OBJECTIVE: Involuntary job loss is a major life event associated with social, economic, behavioural, and health outcomes, for which older workers are elevated risk. Our aim in this study was to assess the 10-year risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers over 50 years of age. METHODS: Analyzing data from the nationally representative U.S. Health and Retirement Survey (HRS), we used Cox proportional hazards analysis to estimate whether workers who suffered involuntary job loss were at higher risk for subsequent MI and stroke than individuals who continued to work. Our sample included 4,301 individuals who were employed at the 1992 study baseline. RESULTS: Over the 10-year study frame, 582 individuals (13.5 of the sample) experienced involuntary job loss. After controlling for established predictors of our outcomes, we found that displaced workers had a more than two-fold increase in the risk of subsequent MI (Hazard ratio HR = 2.48; 95 Confidence Interval CI = 1.49, 4.14) and stroke (HR = 2.43; CI = 1.18, 4.98) relative to working persons. CONCLUSION: Our results suggest that the true costs of late-career unemployment exceed financial deprivation, and include substantial health consequences. Physicians who treat individuals who lose jobs as they near retirement should consider the loss of employment a potential risk factor for adverse vascular health changes. Policy makers and program planners should also be aware of the risks of job loss, so that programmatic interventions can be designed and implemented to ease the multiple burdens of joblessness.}, keywords = {Employment and Labor Force, Health Conditions and Status}, author = {William T Gallo and Teng, H.M. and Tracy Falba and Stanislav V Kasl and Krumholz, H.V. and Elizabeth H Bradley} } @article {7094, title = {The Persistence of Depressive Symptoms in Older Workers Who Experience Involuntary Job Loss: Results from the Health and Retirement Study}, journal = {Journals of Gerontology, Series B: Psychological and Social Sciences}, volume = {61}, year = {2006}, pages = {S221-8}, publisher = {61}, abstract = {Objectives. The purpose of this study was to investigate the association between involuntary job loss among workers nearing retirement and long-term changes in depressive symptoms. Methods. Analyzing data from the first four waves (1992 1998) of the Health and Retirement Survey, we used longitudinal multiple regression in order to assess whether involuntary job loss between Wave 1 and Wave 2 was associated with depressive symptoms at Wave 3 and Wave 4. The study sample included 231 workers who had experienced job loss in the Wave 1 Wave 2 interval and a comparison group of 3,324 nondisplaced individuals. We analyzed the effect of job loss on depressive symptoms both in the full study sample and in subsamples determined by wealth. Results. Among individuals with below median net worth, Wave 1 Wave 2 involuntary job loss was associated with increased depressive symptoms at Wave 3 and Wave 4. We found no effect of involuntary job loss for high net worth individuals at the later survey waves. Discussion. Our findings identify older workers with limited wealth as an important group for which the potential effect of involuntary job separation in the years preceding retirement is ongoing (enduring) adverse mental health.}, keywords = {Employment and Labor Force, Health Conditions and Status, Net Worth and Assets}, author = {William T Gallo and Elizabeth H Bradley and J. A. Dubin and Richard N Jones and Tracy Falba and Teng, H.M. and Stanislav V Kasl} } @article {7029, title = {The Effect of Involuntary Job Loss on Smoking Intensity and Relapse}, journal = {Addiction}, volume = {100}, year = {2005}, pages = {1330-9}, publisher = {100}, abstract = {Aims: To assess the impact of involuntary job loss due to plant closure or layoff on relapse to smoking and smoking intensity among older workers. Design, participants, sample: Data come from the Health and Retirement Study, a nationally representative survey of older Americans aged 51-61 in 1991 followed every 2 years beginning in 1992. The 3052 participants who were working at the initial wave and had any history of smoking comprise the main sample. Methods: Primary outcomes are smoking relapse at wave 2 (1994) among baseline former smokers, and smoking quantity at wave 2 among baseline current smokers. As reported at the wave 2 follow-up, 6.8 of the sample experienced an involuntary job loss between waves 1 and 2. Findings: Older workers have over two times greater odds of relapse subsequent to involuntary job loss than those who did not. Further, those who were current smokers prior to displacement that did not obtain new employment were found to be smoking more cigarettes, on average, post-job loss. Conclusions: The stress of job loss, along with other significant changes associated with leaving one{\textquoteright}s job, which would tend to increase cigarette consumption, must outweigh the financial hardship which would tend to reduce consumption. This highlights job loss as an important health risk factor for older smokers.}, keywords = {Employment and Labor Force, Health Conditions and Status}, author = {Tracy Falba and Teng, Hsun-Mei and Jody L Sindelar and William T Gallo} } @article {6924, title = {The effect of spousal mental and physical health on husbands{\textquoteright} and wives{\textquoteright} depressive symptoms, among older adults: longitudinal evidence from the Health and Retirement Survey.}, journal = {J Aging Health}, volume = {16}, year = {2004}, month = {2004 Jun}, pages = {398-425}, publisher = {16}, abstract = {

OBJECTIVE: To estimate the effect of spousal depressive symptoms and physical health on respondents{\textquoteright} depressive symptoms in a national sample of older married couples.

METHOD: We used data on 5,035 respondent husbands and wives from the 1992 and 1994 waves of the Health and Retirement Survey. Multivariate regression models were estimated to examine the impact of spousal depressive symptoms and physical health on respondents{\textquoteright} depressive symptoms.

RESULTS: Adjusting for respondent mental and physical health and sociodemographic traits, having a spouse with more depressive symptoms was associated with significantly higher follow-up depressive symptoms in the respondent (p < .001). Controlling for spousal depressive symptoms, a decline in the spouses{\textquoteright} physical health was associated with a significant reduction in respondent depressive symptoms (p < .05).

DISCUSSION: Our findings suggest that health care providers treating older adults should be sensitive to the possibility that spouses may be affected when clients suffer poor mental or physical health.

}, keywords = {Aged, Caregivers, depression, Female, Health Status, Humans, Male, Mental Health, Models, Theoretical, Spouses, United States}, issn = {0898-2643}, doi = {10.1177/0898264304264208}, author = {Michele J. Siegel and Elizabeth H Bradley and William T Gallo and Stanislav V Kasl} } @article {6951, title = {Involuntary job loss as a risk factor for subsequent myocardial infarction and stroke: findings from the Health and Retirement Survey.}, journal = {Am J Ind Med}, volume = {45}, year = {2004}, month = {2004 May}, pages = {408-16}, publisher = {45}, abstract = {

BACKGROUND: The role of stress in the development of cardiovascular disease is well established. Previous research has demonstrated that involuntary job loss in the years immediately preceding retirement can be a stressful life event shown to produce adverse changes in physical and affective health. The objective of this study was to estimate the risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers nearing retirement in the United States.

METHODS: We used multivariable survival analysis to analyze data from the first four waves of the Health and Retirement Survey (HRS), a nationally representative sample of older individuals in the US. The analytic sample includes 457 workers who experienced job loss and a comparison group of 3,763 employed individuals.

RESULTS: The results indicate that involuntary job loss is not associated with subsequent risk of MI (adjusted HR = 1.89; 95\% CI = 0.91, 3.93); the risk of subsequent stroke associated with involuntary job loss is more than double (adjusted HR = 2.64; 95\% CI = 1.01, 6.94).

CONCLUSIONS: Our findings present new data to suggest that involuntary job loss should be considered as a plausible risk factor for subsequent cardiovascular and cerebrovascular illness among older workers.

}, keywords = {Female, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Retirement, Risk Factors, Stress, Psychological, Stroke, Unemployment, United States}, issn = {0271-3586}, doi = {10.1002/ajim.20004}, author = {William T Gallo and Elizabeth H Bradley and Tracy Falba and J. A. Dubin and Cramer, L. and Stanislav V Kasl} } @article {6868, title = {Impact of Husbands{\textquoteright} Involuntary Job Loss on Wives{\textquoteright} Mental Health, Among Older Adults}, journal = {The Journals of Gerontology: Social Sciences}, volume = {58B}, year = {2003}, pages = {S30-S37}, publisher = {58B}, abstract = {Objectives. This study estimates the consequences of older husbands{\textquoteright} involuntary job loss for their wives{\textquoteright} mental healthMethods. Using longitudinal data from the 1992, 1994, and 1996 waves of the Health and Retirement Study, multivariate regression models were estimated to measure the impact of older husbands{\textquoteright} involuntary job loss on wives{\textquoteright} mental health. We created two longitudinal data sets of two waves each to use in our analysis. The first data set, or period, combined Waves I and 2 of the Health and Retirement Study and described the 1992-1994 experience of spouse pairs in our sample. It included the wives of 55 husbands who experienced involuntary job loss between these survey dates and a comparison group of wives of 730 continuously employed husbands. The second data set described the 1994-1996 experience of couples. In particular, it included the wives of an additional 38 husbands who were displaced from their jobs between Waves 2 and 3, and a compar ison group of wives of 425 husbands who were continuously employed from 1994 to 1996.Results. Husbands{\textquoteright} involuntary job loss did not have a statistically significant effect on wives{\textquoteright} mental health. We found no evidence that changes in husbands{\textquoteright} depressive symptoms modified the effect of his job loss on wives{\textquoteright} mental health. In the first period only, the effect of husbands{\textquoteright} job loss on wives{\textquoteright} mental health was more pronounced for wives who were more financially satisfied at baseline.Discussion. There is limited evidence among this cohort that husbands{\textquoteright} job loss increases wives{\textquoteright} subsequent depressive symptoms. However, the effect of husbands{\textquoteright} job loss on wives{\textquoteright} mental health appears to be magnified when wives report being financially satisfied pre-job loss. This suggests that, for subgroups of older couples, mental health services specifically targeted at displaced men should also be made available to wives.}, keywords = {Employment and Labor Force}, url = {http://psychsoc.gerontologyjournals.org/}, author = {Michele J. Siegel and Elizabeth H Bradley and William T Gallo and Stanislav V Kasl} } @article {6753, title = {The Impact of Involuntary Job Loss on Subsequent Alcohol Consumption by Older Workers: Findings from the Health and Retirement Survey}, journal = {The Journals of Gerontology: Social Sciences}, volume = {56B}, year = {2001}, pages = {S3-9}, publisher = {56B}, abstract = {OBJECTIVE: To estimate the effect of involuntary job loss on subsequent alcohol consumption by older workers in the United States. METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, the authors estimated multivariate models to assess the impact of involuntary job loss on subsequent alcohol use. Two outcomes were investigated: reported daily alcohol consumption and onset of drinking. The analysis sample included 207 workers who experienced involuntary job loss between survey dates and a comparison group of 2,866 continuously employed workers. RESULTS: After baseline alcohol consumption and a variety of socioeconomic and illness-related covariates were controlled, involuntary job loss was not associated (p .05) with number of daily drinks consumed at follow-up. However, among those who did not consume alcohol at baseline, individuals who suffered involuntary job loss were twice as likely as continuously employed individuals to start drinking by follow-up (OR = 2.01; CI = 1.06-3.80). The majority of those who began drinking at follow-up reported drinking less than 1 drink per day. DISCUSSION: The findings provide evidence of a significant relationship between job loss and subsequent alcohol use among baseline nondrinkers. However, the magnitude of the changes in drinking was quite modest.}, keywords = {Demographics, Employment and Labor Force, Health Conditions and Status, Healthcare, Methodology, Other, Retirement Planning and Satisfaction, Risk Taking}, url = {http://psychsoc.gerontologyjournals.org/contents-by-date.0.shtml}, author = {William T Gallo and Elizabeth H Bradley and Michele J. Siegel and Stanislav V Kasl} } @article {6705, title = {Health effects of involuntary job loss among older workers: findings from the health and retirement survey.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 May}, pages = {S131-40}, publisher = {55B}, abstract = {

OBJECTIVES: To estimate the health consequences of involuntary job loss among older workers in the United States.

METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, multivariate regression models were estimated to assess the impact of involuntary job loss on both physical functioning and mental health. Our analysis sample included 209 workers who experienced involuntary job loss between survey dates and a comparison group of 2,907 continuously employed workers.

RESULTS: The effects of late-life involuntary job loss on both follow-up physical functioning and mental health were negative and statistically significant (p < .05), even after baseline health status and sociodemographic factors were controlled for. Among displaced workers, reemployment was positively associated with both follow-up physical functioning and mental health, whereas the duration of joblessness was not significantly associated with either outcome.

DISCUSSION: The findings provide evidence of a causal relationship between job loss and morbidity among older workers. This relationship is reflected in both poorer physical functioning and mental health for workers who experience involuntary job loss. In addition to the economic consequences of worker displacement, there may be important health consequences of job loss, especially among older workers.

}, keywords = {Activities of Daily Living, Adaptation, Psychological, Aging, Female, Geriatric Assessment, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Unemployment, United States}, issn = {1079-5014}, doi = {10.1093/geronb/55.3.s131}, author = {William T Gallo and Elizabeth H Bradley and Michele J. Siegel and Stanislav V Kasl} }