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TOPIC 5. GENDER AND WORK IN HEALTH INEQUALITIES |
1 Department of Sociology
2 Children's Health Research Institute
3 Aging & Health Research Centre, The University of Western Ontario, Canada.
Address correspondence to Dr. William R. Avison, Department of Sociology, The University of Western Ontario, London, Ontario, Canada N6A 5C2. E-mail: wavison{at}uwo.ca
Abstract
We estimate the effects of single parenthood on parental health and determine whether such effects are similar for all single parents or whether there are variations by gender among young, middle-aged, and older adults. The results of our analyses of the Canadian National Population Health Survey (NPHS) reveal that single parenthood is associated with elevated psychological distress and alcohol consumption among women, especially among those who are in younger age groups. Although we find no such differences among men, there is some indication of elevated distress among younger fathers. We discuss the implications of these findings for thinking about single parenthood at various life stages.
OVER the past 30 years, patterns of marriage, cohabitation, and divorce in North America have contributed to substantial numbers of single-parent families in the United States and Canada. The United States has had one of the highest rates of both marriage and divorce in the world, and these patterns have contributed to large numbers of families headed by a separated or divorced parent. Although rates of marriage and divorce have declined in the United States since 1980, they still remain relatively high: The rate of marriage was 8.5 per 1,000 and the rate of divorce was 4.1 per 1,000 in 2000. By contrast, the marriage rate in Canada was 4.7 per 1,000 and the divorce rate was 2.3 per 1,000 in 2000.
In addition, the proportion of all live births occurring among unmarried women has risen in both countries. In the United States, this figure rose from 18 percent in 1980 to 32 percent by 2001. In Canada, 18 percent of all live births were to unmarried mothers in 1985, and this rose to 31 percent by 1996. Although the issue of unwed motherhood is often thought to be primarily a problem of teenage pregnancy, census data suggest otherwise. The steepest rise (more than doubling over the past 20 years) and the highest rate of unwed motherhood in the United States is found in the 20- to 24-year age group, followed closely by the 18- to 19-year and the 25- to 29-year age groups. These trends probably reflect the growing numbers of cohabiting couples (Bumpas, Sweet, & Cherlin, 1991
) and the increasing acceptance of childbearing outside of marriage. Across a number of disciplines, these demographic trends have raised a number of questions about the impact of family structure on individuals' health and well-being.
In the sociology of mental health, there has been growing interest in estimating the impact of single parenthood on a variety of outcomes. A primary focus of this work has been to explain the higher rates of psychological distress among single parents compared to married or cohabiting parents. Because the vast majority of single parents have been women, it has been difficult to disentangle the effects of gender and family structure on health. In other words, it is unclear whether the impact of family structure on health is largely confined to single mothers or whether single fathers are also at elevated risk of health problems. Perhaps because of the almost exclusive emphasis on mothers, this literature has also focused primarily on internalizing styles of distress, which are more prevalent among women.
Given that previous research has focused mainly on young single parents, the fact that single parenthood is a status that cuts across all age groups has been virtually ignored. Indeed, it is reasonable to expect that the context of being a sole parent may be quite different depending upon life stage, with important health consequences. In this article, we estimate the effects of single parenthood on parental health and determine whether such effects are similar for all single parents or whether there are variations by gender among young, middle-aged, and older adults.
Family Structure and Mental Health
The emergence of single-parent families as a relatively prevalent family structure has generated a number of interesting research questions in the sociology of health and mental health. Principally, these questions have focused on searching for explanations of the elevated levels of psychological distress among women who head single-parent families compared to those in two-parent families. Much of this research concludes that the substantial disadvantage in incomes experienced by single mothers and their much greater exposure to an array of stressors account for this difference (Ali & Avison, 1997; Avison, 2002; Brown & Moran, 1997; Coll & Surrey, 1998; Davies, Avison, & McAlpine, 1997; Lorenz, Simons, & Chao, 1996; McLanahan, 1983). Researchers have documented the problems encountered by single mothers by examining the relatively enduring circumstances that characterize single parenthood as a relatively stable family structure (e.g., Benzeval, 1998; Brown & Moran, 1997; Demo & Acock, 1996; Furstenberg & Cherlin, 1991; Hall, Gurley, Sachs, & Kryscio, 1991; Kitson & Morgan, 1990; McLanahan, 1983, 1985; McLanahan & Booth, 1989; McLanahan & Sandefur, 1994). These studies provide substantial evidence concerning the impact of stress on the psychological distress of single mothers. A range of factors has been identified in these studies as characteristics associated with single motherhood that are expected to have negative mental health consequences. These factors include economic hardship and poverty, caregiving stress, deficits in social support, and the erosion of self-esteem and mastery (e.g. Avison, 1995; Benzeval, 1998; Brown & Moran, 1997; Demo & Acock, 1996; Kitson & Holmes, 1992; Simons, Johnson, & Lorenz, 1993).
These studies are valuable because they direct attention to the structural forces that shape the experiences of single mothers. However, with some exceptions (e.g. Demo & Acock, 1996; Lorenz et al., 1996; McLanahan, 1985), much of the research in this area has not been on population-based samples of single-parent families, and there has been a striking absence of any comparison with samples of mothers in two-parent families. Even more striking is the virtual absence of any research that compares the experiences of mothers and fathers from single-parent and two-parent families. A further limitation of this work is its reliance on mental health indicators that are limited to symptoms of depressive affect or psychological distress (Umberson & Williams, 1993). It seems reasonable to expect that the stressors of single parenthood are manifested differently for men and women (Aneshensel et al., 1991; Horwitz & Davies, 1994) and that any comparisons by gender ought to include multiple measures to capture this possibility.
There is yet another criticism that can be leveled at most research on family structure and health: Much of this work ignores the potential contextual effects of the life course. The vast majority of studies of single motherhood and health has focused on women in their late teens, 20s, or 30s. As the number of single mothers grows, so too does the number in older age cohorts. However, we know almost nothing about the health of older lone parents.
In this article, we present the results of analyses that explore the effect of family structure on psychological distress and alcohol consumption among men and women and identify any variations across age stage. Our aim is to extend the research on single parenthood and health to determine whether single fathers' experiences of lone parenthood have health consequences that are similar to those experienced by single mothers. We also aim to assess whether these relationships persist among younger, middle-aged, and older parents.
METHODS
One of the challenges in addressing these questions is to locate a data set that has sufficient numbers of mothers and fathers in both single and two-parent families with substantial variation in age. In addition, we required a survey data set that included reasonable measures of financial difficulties as well as an array of measures of other dimensions of stressful experience. Finally, the data set must have included reliable and valid measures of both psychological distress and alcohol consumption to assess outcomes that are gendered (Aneshensel et al., 1991; Horwitz & Davies, 1994).
Few surveys meet all of these criteria. The Canadian National Population Health Survey is one such data set. The NPHS is a national survey that initially sampled 26,429 households from across Canada in 1994. After excluding households in which no family member was over age 25 and after taking into account modest nonresponse (just over 11 percent), the survey successfully collected data from 17,626 Canadians.
In this article, we limited our analyses to parents between the ages of 20 and 64 with at least one child residing at home with them. This resulted in a subsample of 5,598 respondents. Approximately 44 percent are mothers in two-parent families, and just under 14 percent are single mothers; almost 40 percent of the sample are fathers in two-parent families, and just over 2 percent are single fathers.
Measures
Family structure
For the purposes of this article, we define family structure in terms of a dichotomous variable. Two-parent families are those in which a married or common-law couple live with at least one dependent child under age 25. Single-parent families are those in which a parent without a married or cohabiting partner lives with at least one dependent child under age 25.
Psychological distress
We use a 6-item index derived from a longer scale that was developed for the U.S. National Comorbidity Study. Scores may range from 0 to 24 with higher values indicating more distress.
Alcohol consumption
Respondents reported how many times in the past year they consumed more than five drinks on any one occasion.
RESULTS
Table 1 presents the results of multiple regression analyses that estimate the effects of family structure, gender, and age on psychological distress. As can be seen in the first two models, family structure and gender have independent effects on psychological distress. In Model III, the statistically significant interaction indicates that the effect of family structure on distress is stronger for mothers than for fathers. In Model IV, the addition of age to the regression equation results in a nonsignificant interaction of family structure and gender on psychological distress. This suggests that the gendered effect of family structure on psychological distress must vary somewhat by age.
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Variations by Age Groups
To examine more closely the effects of family structure in the context of the life course, we divided the sample into three age groups (20–34, 35–49, and 50–64) and re-examined the effects of family structure on our two outcomes of interest within gender. Table 3 summarizes these analyses. Tests of mean differences by family structure are presented separately for females and males.
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Among fathers, there are no significant differences by family structure for any age group; however, two patterns deserve comment. First, it is interesting to observe that younger single fathers and single mothers (ages 20–34) have almost identical levels of distress, and the difference in distress between single- and two-parent fathers for this age group is almost identical to the difference among mothers. Second, we observe a monotonic decline with age in the difference in distress for single- and two-parent fathers. The absence of significant differences among fathers seems likely to be a problem of sampling power.
For alcohol consumption, single mothers report significantly higher scores than do married mothers (as we noted earlier in Table 2), but closer inspection of these data reveals that this difference is largely attributable to those women aged 20–34. Once again, however, a test of the interaction of age and family structure was nonsignificant. Among fathers, there is no significant difference attributable to family structure. Nevertheless, there is certainly some indication of elevated alcohol consumption among middle-aged single fathers compared to their married counterparts. The relatively small subsample sizes and substantial variances in alcohol consumption constrain our ability to adequately test for significant differences.
DISCUSSION
These preliminary results have interesting implications. First, single parenthood has consequences for both psychological distress and alcohol consumption among women. Of course, the effect of single parenthood on the distress of women has been widely documented. Our results suggest that the health consequences of single parenthood extend to alcohol consumption. In general, these health consequences are more pronounced among younger rather than older mothers. Thus, the effects of family structure on women's lives become more apparent when we consider more than one outcome.
The experiences of single fathers are more difficult to characterize. Although there are no significant differences in health outcomes between single- and two-parent fathers, some patterns are suggestive of the effects of family structure. The fact that there are so few single fathers limits our ability to identify statistically reliable differences. Single fathers in the youngest age group have levels of psychological distress similar to those of their female counterparts. Perhaps the challenges associated with combining caregiving and provider roles among younger persons are particularly difficult for fathers. For them, sole fatherhood may be a relatively new role and not as anticipated. Middle-aged single fathers have exceptionally elevated alcohol consumption compared to married fathers. For them, being a male primary caregiver is a role that is neither normative nor common.
Our results also suggest that the relationship between family structure and psychological distress and alcohol consumption varies by life stage. It appears that the mental health consequences of single parenthood are least among those between 50 and 64 years. It is likely that these single parents have older children and, therefore, are not as enmeshed in the overlapping spheres of work and family demands. This finding is more pronounced among fathers.
A limitation of these data is that we cannot determine the length of time that individuals have occupied the role of single parent. Individuals move in and out of single parenthood throughout the life course; family structure is more dynamic and changeable than is implied by the snapshot presented here. This data set does not allow us to assess whether single parenthood is more stressful among those for whom it is an enduring status or how this might translate into levels of distress and alcohol use. The cross-sectional nature of these data ought to make us cautious in interpreting these patterns in terms of age effects. A much different design will be required to address life-course issues. Indeed, we are embarking on a 14-year follow-up of an original study of 500 single and 500 married mothers (Ali & Avison, 1997; Avison, 2002; Davies et al., 1997) to address these issues.
In the meantime, we intend to further investigate these preliminary findings from the NPHS to better understand the gendered patterns that we have observed. In so doing, we hope to gain additional insights into the ways that gender, family structure, and stress produce varied consequences for the health of parents.
Acknowledgments
Support for this paper was provided by a grant to Roderic Beaujot from the Health Policy Research Program of Health Canada and by support to William R. Avison from the Children's Health Research Institute.
References
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