If Americans with higher incomes report higher levels of happiness, why have reported levels of happiness declined during the past fifty years when living standards and incomes have increased? Among economists, prevailing theories to explain the paradox rest on one of two claims: 1) that happiness depends more on whether one’s income matches that of peers than whether it matches or exceeds that of their parents at the same point in the life cycle; or 2) that happiness has declined for many as household income has grown more unequal. A study by three Italian economists, however, offers a more compelling explanation, finding that a decline in “social connections,” particularly in marriage, has played a significant role in depressing the American mood.

Bartolini of the University of Siena and his colleagues came to their conclusion after discovering, in their first set of regressions using U.S. General Social Survey data between 1972 and 2004, that several variables—including changes in household income, reference income (a measure of income relative to peers), work status, and demographic characteristics—did not satisfactorily account, in their most sophisticated models, for the decline in self-reported happiness over the same time period. However, their second set of regressions explored the relationship between happiness and variables that measure what they call “social connections and confidence in institutions” or SCC for short. In these tests, the economists were able to find a “more precise prediction of the [un]happiness trend.”

The SCC variables included marital status, number of children, social contacts, trust in individuals, group membership, and confidence in institutions. In later analysis, the researchers found that all these measures had declined between 1975 and 2004. But in the second set of regressions, all the SCC variables save number of children were found to be significantly linked with reduced happiness. More to the point, marital status was found to be the most determinative factor in these regressions, consistently correlating with happiness (p<0.01) in all tests. Indeed, the researchers found “that about three quarters of the total happiness variation predicated by all SCC indicators is due to the deterioration of marital status.”

Moreover, the economists found that Americans in second marriages were not as happy as their peers in first marriages, “even without consideration the happiness reduction due to a divorce.” Although the Italian scholars don’t explicitly make the connection, their findings related to “social contacts” explain, in part, why marital status represents the trump card of their study, as marriage appears to direct individuals to a more fulfilling social life centered around family. As they report:

Spending evenings with relatives, neighbors, or friends correlates with a greater happiness, while spending evenings in a bar is associated with a lower level of happiness. More precisely, spending at least one evening with relatives goes with twice the happiness of spending one evening with friends or neighbors. Spending at least one evening at a bar is associated with less happiness, as much as spending evenings with relatives correlates with greater happiness.

Yet the study does more than simply confirm the connections between marriage and happiness. The Italian economists make an impressive, empirical case that the decline in American happiness related to declines in social connections—coupled with changes in reference income—“more than offsets” any increase in happiness arising from increases in household income since the 1970s. Their findings therefore go a long way to explain a paradox that has puzzled their fellow economists while confirming that money, indeed, does not buy happiness.

(Stefano Bartolini, Ennio Bilancini, and Maurizio Pugno, “Did the Decline in Social Connections Depress Americans’ Happiness?” forthcoming in Social Indicators Research.)

In awarding “performance bonuses” last December to twenty-three states that signed up 1.2 million children for Medicaid and the Children’s Health Insurance Program (CHIP), the Obama administration claimed that the expansion of the welfare state advances the well-being of children. Yet if the interests of children are really a priority, why is the current administration ignoring an underlying factor that leaves children most at risk of being uninsured: the retreat from marriage by their parents? According to a study by two Oklahoma sociologists, children living with married parents are significantly more likely to have private health-care insurance than are their peers whose biological parents are not married.

Loretta Bass of the University of Oklahoma and Nicole Warehime of Oklahoma Baptist University examined data of the Fragile Families and Child Well-being Study, measuring the relationship between family structure and child health outcomes at age 5. The researchers looked at data—collected for children born to 1,186 married mothers and 3,712 unmarried mothers between 1988 and 2000—to explore the effects of parental marital status on three measures: the child’s health insurance type, the child’s having a routine medical doctor, and the child’s being reported in excellent health.

While the percentages of all children having a medical doctor (74 percent) and being reported in excellent health (64 percent) were relatively high, children of married parents had the highest percentages (84 percent and 68 percent, respectively). While these differences may not seem striking, children were significantly more likely to be covered under private health insurance, and less likely to be on Medicaid, if their biological parents were married than if their parents were in the three other parental-relationship categories (cohabiting with each other; are romantically involved; or are not romantically involved). The correlation was robust and pronounced (p<0.001 for all three relationship categories), and remained so in the statistical model that controlled for demographic factors, including mother’s race, age, and education. In the controlled model, children of cohabiting parents were more than seven times to have no private insurance and almost four times more likely to receive Medicaid benefits, than their peers with married parents.

Similar results were found on the question of having a routine medical doctor. Children of married parents were significantly more likely to have a routine medical doctor than were their peers with parents from the other three categories. Although the magnitude of the relationship was attenuated in the controlled statistical model, the coefficients remained statistically significant.

Commenting on their findings, the Oklahoma scholars not only claim “that family structure matters” but also that “policymakers should note the importance of biological parents’ relationships in shaping children’s access to health insurance.” Given this admonition, perhaps the Obama administration should award performance bonuses to states not on the basis of increasing welfare dependency but rather on the basis of increasing the percentage of children living with married parents.

(Loretta E. Bass and M. Nicole Warehime, “Family Structure and Child Health Outcomes in the United States,” Sociological Inquiry 81.4 [November 2011]: 527–48.)

Nearly a century ago, Theodore Roosevelt warned that unless the average man and woman would have at least three children, the country would die a slow death. Judging from the latest report from the National Center for Health Statistics, the vital signs of the United States, as reflected in birthrates, are not encouraging. For the third year in a row (2010), measures of childbearing have declined, a pattern that not only matches declines the country suffered in the early 1970s but also reverses the trajectory of modest increases in rates of U.S. childbearing between 1998 and 2007.

The preliminary estimate of the total number of births in 2010 (4.0 million) represents a drop of 3 percent from 2009, and a decline representing the largest absolute decrease since 1972. Likewise, the preliminary General Fertility Rate declined by 3 percent to 64.1 births per 1,000 women of childbearing age. The preliminary Total Fertility Rate (TFR), the estimate of the number of births that the average woman would have over her lifetime, dropped to 1.93, also a 3-percent drop, from 2.00 in 2009. Moreover, the preliminary TFR in 2010 represents a 9-percent decline since 2007, when the TFR was 2.12, the highest since 1972.

While all three measures had been improving every year from 1998 to 2007, the setbacks in 2008, 2009, and 2010 turn back the clock to what birthrates were in 1999. Yet with declining fertility, the portion of births occurring outside of wedlock remains historically high; 41 percent of all births in the United States in 2010 were to unwed mothers.

Demographic Intelligence, a demographic-forecasting firm headed by Brad Wilcox of our editorial board, believes that these years of declining fertility are a fluke, a by-product of the Great Recession. Its “U.S. Fertility Forecast” projects birthrates will rebound modestly to 1.98 this year. Nonetheless, that projected number not only remains under pre-recessionary fertility levels but also well short of the TFR that Theodore Roosevelt claimed represented a healthy society. That projection may also be optimistic, given President Barack Obama recent decision to pay American couples not to have children through “free” birth control via employer-provided health-care plans. If that order goes unchallenged, look for continued declines in birthrates and continued increases in the proportion of all births to unmarried women.

(“Births: Preliminary Data for 2010,” National Vital Statistics Report, Vol. 60, No. 2, November 2011).

Public-health officials strive very hard to find ways to help smokers quit the habit—targeting poor smokers particularly, because poor men and women are more likely to light up than are men and women of higher economic status (though they suffer more relative economic deprivation as a result of the costly habit than do their more affluent smokers), and because poor smokers cannot pay for the expensive therapies that can make quitting easier. But readers of an Australian study of community-based organizations that work with poor smokers may wonder if officials should consider strategies for reinforcing wedlock. For this study indicates clearly that even among the poor, married men and women are distinctively resistant to the appeals of tobacco merchants.

To analyze smoking among Australia’s poor and to assess their likelihood of quitting smoking, researchers from the University of Newcastle examined data collected in 2010 from 383 men and women working with social-service organizations, identified as “non-government, not-for-profit organisations that provide welfare services to disadvantaged individuals.” These data indicate: “Disadvantaged smokers have a desire to quit smoking that is comparable to the general population.”

Unfortunately, these data also indicate that “a relatively small proportion” of the smokers surveyed had used “strategies known to increase quit[ting] success, including using nicotine replacement therapy and behavioural support.” Highlighting a particularly underutilized form of behavioral support, the researchers lamented that few of the smokers surveyed had “contacted the telephone Quitline, and few showed interest in receiving this type of support.” Indeed, the researchers find it unsettling that over a third of the smokers they surveyed expressed a desire “to access acupuncture and hypnosis, despite there being no evidence of the effectiveness of these types of support.” To counter this kind of thinking, the researchers call for “strategies to increase engagement of disadvantaged smokers with evidence-based cessation interventions.”

“Evidence-based” thinking about smoking among the poor, however, might involve considerations other than just nicotine patches or help hotlines. The researchers report that among the disadvantaged Australians surveyed, marital status emerged as a significant statistical predictor of tobacco use. Compared to married peers, the researchers conclude, those who were “never married or single . . . were . . . significantly more likely to smoke” (p<0.01).

This finding, predictably, harmonizes with a body of American research finding that marriage fosters better health habits by inculcating a sense of responsibility and obligation. At a time when public officials around the world are seeking ways to hold medical costs in check, the distinctive resistance of married individuals to the health-destroying tobacco habit deserves attention.

(Jamie Bryant, Billie Bonevski, and Christine Paul, “A Survey of Smoking Prevalence and Interest in Quitting among Social and Community Service Organisation Clients in Australia: A Unique Opportunity for Reaching the Disadvantaged,” BMC Public Health 11 [October 26, 2011]: 827.)

With in-vitro fertilization (IVF), some infertile couples have seen a way to have children that nature has apparently denied them. Using this  technology, some single women and lesbian couples have seen a way to have children without marital ties to a man. Regardless of motives, women resorting to IVF may be running unrecognized cancer risks.

The evidence that IVF entails seriously elevated cancer risks comes from a study by researchers at the Netherlands Cancer Institute, University Medical Center Utrecht, Leiden University Medical Center, and Vrije Universiteit Medical Center. Analyzing data collected from 19,146 women who received IVF treatment in the Netherlands between 1983 and 1995, the researchers identified a disturbingly high incidence of ovarian cancer among these women.

More particularly, the researchers calculated a standardized incidence rate (SIR) of borderline ovarian tumors of 1.93 among women who had undergone IVF with the incidence of such tumors in the general population. In other words, “women treated with ovarian stimulation for IVF have a 2-fold increased risk of ovarian malignancies compared with subfertile women not treated with IVF.” When the researchers shifted their focus from borderline ovarian tumors to invasive ovarian cancer, they found that women who had undergone IVF did not manifest any statistically significant elevation of risk—in the short run. However, when the researchers examined the longer-term pattern, they discovered that the SIR for invasive ovarian cancer came in at 3.54 for women who had undergone IVF fifteen years or more previously. The scholars labeled this finding “concerning.”

These findings were not entirely unexpected, since medical authorities had previously expressed “concerns . . . that ovarian stimulation and multiple ovarian punctures as used in IVF may increase the risk of ovarian malignancies.” But at a time “when 1.2–2.3% of children born in the Western world are conceived by assisted reproductive technologies,” this new study should raise urgent questions about the safety of such technologies.

(F. E. van Leeuwen et al., “Risk of Borderline and Invasive Ovarian Tumours after Ovarian Stimulation for In Vitro Fertilization in a Large Dutch Cohort,” Human Reproduction 26 [October 26, 2011]: 3456–65.)

Keen observers of the college scene note that since the 1980s, young women have outnumbered young men as students as well as graduates, a pattern that shows no signs of changing. Some see the emergence of a knowledge-based economy as driving men from college campuses. Yet economists from the University of Chicago and the National University of Singapore may be the first to point to another driver of reduced educational outcomes among young men: the breakdown of the family, particularly the rise of unwed or divorced motherhood, which places sons at a significant disadvantage in academic pursuits from the earliest ages.

Marianne Bertrand and Jessica Pan examine data from the National Educational Longitudinal Survey (NELS) and the National Longitudinal Survey of Youth (NLSY) to measure the role of non-cognitive skills in educational achievement. Conducting a wide range of regressions using both datasets, they find a statistically significant relationship between school suspension and the likelihood of graduating from high school, attending college, and earning a bachelor’s degree.

Building upon existing research establishing that “non-cognitive deficiencies” associated with school suspensions are significantly more common among boys than among girls, the two economists then set out to explore factors that explain why boys are particularly likely to engage in disruptive and acting-out behaviors such as aggression and delinquency. Their findings will not please diversity advocates who claim all families are equal: the researchers discover that home environment—not school environment—determines “the especially large gender gap” that emerges by middle school:

Family structure is an important correlate of boys’ behavior deficit. Boys that are raised outside of a traditional family (with two biological parents present) fare especially poorly. For example, the gender gap in externalizing problems when the children are in fifth grade is nearly twice as large for children raised by single mothers compared to children raised in traditional families. By eighth grade, the gender gap in school suspension is close to 25 percentage points among children raised by single mothers, while only 10 percentage points among children in intact families. Boys raised by teenage mothers also appear to be much more likely to act out.

Stressing the consistency of their findings, the researchers find no variations based upon factors such as age of entry into kindergarten, the quality of the school, teacher gender, or peers’ non-cognitive skills.

In seeking to explain these robust differences, Bertrand and Pan blame the emotional dynamics of broken homes, which they find wanting: “The most robust difference across family structures appears to be with respect to the emotional distance: single mothers appear especially distant from their sons.” Although the researchers find that married and unmarried mothers alike are closer to daughters than their sons, they report that the difference between the mother-son emotional gap and mother-daughter emotional gap is decidedly smaller in intact families than it is in broken families. This pattern may also explain why the researchers also found that boys are more likely than girls to be spanked in the past week in broken homes than are their peers from an intact home.

These findings go a long way toward connecting the dots between the rise of unwed childbearing and changing college-enrollment patterns, developments that have occurred almost simultaneously in America. Yet the researchers’ interest in the subject is more than academic, as they lament the real-world consequences: “Boys’ non-cognitive deficit might be a primary factor holding them back from completing the higher levels of education that are demanded in the skill-biased economies that now characterize most developed countries.”

(Marianne Bertrand and Jessica Pan, “The Trouble with Boys: Social Influences and the Gender Gap in Disruptive Behavior,” National Bureau of Economic Research, Working Paper 17541, October 2011.)

Every four years, the media hector GOP presidential candidates and nominees for their views on same-sex marriage. The presumption is that the GOP platform, which has opposed changing the legal definition of marriage to suit the liberal imagination, is unfair to minorities, in this case, “sexual minorities.” Yet the latest data from the U.S. Census Bureau indicates that the numbers of same-sex households that would actually seek such a classification is so microscopic that one wonders why the media are so preoccupied with the matter.

Dramatically lowering former guesses of the number of same-sex households, the U.S. Census Bureau last fall released numbers, based upon the 2010 census, estimating that the United States has 646,464 same-sex households, including 131,729 same-sex couples who have been “married” in states that sanction such relationships. The actual Census numbers come in a bit higher than those arising out of 2010 data from the bureau’s American Community Survey (ACS), which claims 593,324 same-sex households, including 42,195 same-sex “married” households.

These numbers mean that between 515,000 and 551,000 U.S. households represent “unmarried” same-sex couples, households that would supposedly benefit if same-sex marriage were imposed upon all fifty states. When compared to Census Bureau data indicating a total of 117.5 million households in the country in 2010, that means that only about four- or five-tenths of 1 percent of households could take advantage of being granted the legal status of same-sex marriage.

Other Census Bureau data confirm the numerical insignificance of these households. A paper on ACS data for 2010 reports that vital-statistics records show that less than 50,000 same-sex marriages were recorded by civil authorities in the United States from 2004 and 2010. That compares to about 14 million natural marriages that were recorded during the same period, meaning that marriages that are deemed same-sex represent less than four-tenths of 1 percent of natural marriages.

These tiny numbers debunk any notion that the electorate is demanding action on what the media consider a substantive civil-rights issue. The general population mainfests no groundswell of interest in same-sex marriage. More to the point, the numbers suggest that not even the small percentage of Americans who identify themselves as homosexual seem all that interested.

(Daphne Lofquist, “Same-Sex Couple Households,” American Community Survey Briefs, U.S. Census Bureau, September 2011.)

When she wrote The Feminist Mystique in 1963, Betty Friedan claimed that the life of a full-time mother and homemaker confined women to a miserable existence. While media and academic elites continue to drink the Kool-Aid, an international team of sociologists finds that, all things being equal, married homemakers around the world are indeed not only happy but also significantly happier than their peers who work full time outside the home.

Granted, the standardized-mean difference between the two sets of wives in their most sophisticated model is modest (0.11), leading the researchers to caution that “homemakers enjoy only a small advantage.” Nonetheless, that small advantage is robust enough (p<0.001) to debunk any feminist assertion that women cannot find fulfillment without a career. Moreover, in none of the twenty-eight countries surveyed were wives who worked full time in the labor market significantly happier than their peers who were homemakers.

These aren’t the only findings that prompt the researchers to caution “against equating employment with satisfaction.” Drawing on data from the 2002 Family and Gender module of the International Social Survey Program representing more than 7,000 married women, Judith Treas of the University of California (Irvine) and her international colleagues also found that homemakers who work part time in the labor force are no happier than their peers who don’t work outside the home at all. In other words, the real happiness gap among married women is between those who work outside the home full time and those who are employed part time or not at all. (These findings confirm that labor statistics, which often group homemakers who have part-time jobs together with their career-oriented sisters, and not with homemakers out of labor market, can be misleading.)

In fact, being a homemaker appears to be the most reliable predictor of the happiness of married women throughout the study. As might be expected, family income, husband’s share of domestic duties, wife’s perception of fairness in the division of household labor, couple conflict, and family stress were also found to be related to the happiness of married woman. Yet controlling for these mediating variables, write the researchers, “exacerbates rather than eliminates the homemaker’s happiness advantage.” Nor did national differences in social spending, liberal gender ideology, per-capita GDP, and female labor-force participation rate eliminate the homemaker’s advantage. In general, higher measures of these factors in cross-national analyses only slightly reduced the disadvantage in happiness of wives who work full-time outside the home.

While Treas and her colleagues do not back away from their findings, nor attempt to spin the results, they nonetheless believe their study should encourage “future efforts to understand what about countries makes women’s full-time employment a more or less satisfying experience.” Not to read too much into this one sentence, but why not a call to understand the factors that make wives that devote their attention to the home (with or without part-time jobs) the happier breed? At least in the case of these homemakers, happiness does not place demands on the taxpayer in the form of higher social spending or daycare subsidies.

(Judith Treas, Tanja van der Lippe, and Tsui-o Chloe Tai, “The Happy Homemaker? Married Women’s Well-Being in Cross-National Perspective,” Social Forces 90.1 [September 2011]: 111–32.)

What circumstances would reverse the sharp fall of marriage rates in recent decades? Sociologist Matthijs Kalmijn of Tilburg University in the Netherlands argues that marriage rates would rise if the economy changed in ways that made young men better able to take on the breadwinner role by enhancing their employment prospects. In advancing his empirically grounded argument, Kalmijn acknowledges his debt to Valerie Oppenheimer, an American social theorist he credits with “bringing men back into the debate” over the decline in marriage rates evident throughout the Western world.

At the time that Oppenheimer began her work, the notion that “men’s economic position influenced marriage formation . . . was generally not a popular idea.” What was popular was the belief that the “erosion of marriage” was the inevitable result of “the growing economic role of women in society.” Also popular: the belief that the decline in marriage was the consequence of “value change, and in particular to the increasing need for individual autonomy on the one hand, and the ideological condemnation of traditional institutions like marriage on the other.”

Not persuaded by these arguments, Oppenheimer asserted that marriage rates would not have declined had men not suffered a significant loss in economic status. This loss was evident in “the poor and uncertain economic prospects of young men.” These unfavorable prospects left young men “unable to fulfill the role of breadwinner” and therefore “not . . . attractive marriage partners and fathers,” particularly since they could not promise long-term security. To test Oppenheimer’s hypothesis, Kalmijn parsed data collected between 1994 and 2001 from 17,743 men in thirteen European countries (Denmark, Finland, Germany, Austria, the Netherlands, Belgium, France, the United Kingdom, Ireland, Portugal, Spain, Italy, and Greece). These data largely validate Oppenheimer’s views on the importance of men’s economic status in determining marriage rates.

After analyzing his data, Kalmijn calculated that “the odds of entering a union are 58% higher for employed men than for men who are not employed and not in school. What is more, the numbers indicate that “employed men have a 48% higher odds of marrying rather than cohabiting.” It appears that “nonemployment is less incompatible with cohabitation than with marriage.” Kalmijn likewise reports, “Compared to men with a permanent job, men with a temporary job who enter a union are 23% less likely to choose marriage than cohabitation.” But unlike permanent employment, “school enrollment has a negative effect on union entry” for men, whether the union is wedlock or cohabitation.

Through further investigation, Kalmijn establishes the importance of men’s income, not just their employment status, in determining marriage rates. “My analyses,” Kalmijn writes, “show that income effects are strong and significant, which supports the male breadwinner hypothesis.”

Clearly, Kalmijn has reason to conclude that “by and large, the European evidence supports the theory” advanced by Oppenheimer as to the importance of men’s economic status in determining marriage rates. What is more, Kalmijin sees his findings as in line with findings of American studies. “American research,” he remarks, “generally supports the view that poor economic prospects for men are associated with a delay in marriage. This has been demonstrated for a range of indicators, including employment per se, unstable employment, low earnings, and other indicators of career ‘immaturity.’”

Kalmijn attaches great importance to this international validation of Oppenheimer’s emphasis on men’s economic status as a potent determiner of marriage rates. After all, while some social theorists offered little hope for a renewal of wedlock, “Oppenheimer’s theory has a more optimistic implication for the future of marriage.” After all, with the right changes, “the economic position of young men could improve and this would then have positive repercussions for marriage.”

In assessing Kalmijn’s European findings, Americans will want to remember that European countries vary considerably in the cultural orientations, especially since Kalmijn’s data indicates that “the effects of men’s employment and school enrollment on union formation are stronger in more traditional societies than in more egalitarian ones. Income effects are also weaker in egalitarian societies.” In other words, if the economic circumstances of young men improve in a Red State such as Oklahoma or Kentucky, that improvement will probably translate into a sharper upturn in the marriage rate than the same kind of economic change for young men in a Blue State such as Massachusetts or Washington.

(Matthijs Kalmijn, “The Influence of Men’s Income and Employment on Marriage and Cohabitation: Testing Oppenheimer’s Theory in Europe,” European Journal of Population 27.3 [August 2011]: 269–93.)

Married individuals enjoy such pronounced advantages in health and longevity over unmarried peers that researchers are now intent on figuring why. Two studies—one by researchers in the United States and one by researchers in Canada—suggest that these advantages derive at least in part from the fact that married men and women receive better medical care than their unmarried peers.

The medical advantage that married individuals enjoy over single peers shows up clearly in a study by health researchers at Brigham Young University. By parsing data from the National Cancer Institute for 2,726,147 cases of cancer diagnosed between 2000 and 2007, the researchers identified the social characteristics most often present among men and women who received a cancer diagnosis that included staging, part of a thorough diagnosis spelling out the size of the tumor(s), the number of lymph nodes affected, and the presence or absence of metastasis. Not surprisingly, a diagnosis that includes staging “provides direction on an appropriate course of treatment.”

Marital status, as it turns out, predicts the likelihood of a patient having his cancer staged as part of the diagnosis. “Married individuals,” report the researchers, “were significantly more likely to receive a cancer staging [than were unmarried peers], after adjusting for age, sex, and race.” The researchers note that their findings are “consistent with findings from studies showing that married cancer patients tend to be identified at an earlier stage of disease, experience fewer comorbid conditions, and have better prognosis” than do unmarried peers. The BYU scholars further align their findings with those of an earlier study concluding that “women who were married . . . were more likely to undergo mammography and receive pap testing than single women.” Explaining the pattern, the researchers comment, “Married women enjoy the benefit of a combined income and a stable partner, which increases their likelihood of being able to afford appropriate medical services.”

The medical advantage associated with wedlock likewise appears in the Canadian study. Conducted by researchers at the University of Toronto and McGill University, this study examines the relationship between the social characteristics of those suffering heart attacks and the rapidity with which they seek hospital medical care after first experiencing chest pain. The researchers bring these relationships into focus by analyzing medical records for 7,746 patients with acute myocardial infarction (i.e., heart attack) diagnosed in eighty-two hospitals in Ontario.

Defining six hours from onset of chest pain to arrival at the hospital as their cut-off for timely treatment, the researchers conclude that “being married was associated with lower odds of delayed presentation” at the hospital for treatment (p<0.001). Compared to single peers, married men experiencing chest pain were about one-third as likely to delay their trip to the hospital (odds ratio, 0.35). “Earlier attainment of medical care,” remark the scholars, “may be one reason why married men have a lower risk of cardiovascular mortality than their single counterparts.”

The researchers did not find the same kind of statistically significant reduction of treatment delay when they compared married women experiencing chest pain to single women experiencing the same symptoms. This gender disparity in the effects of marital status does not surprise the Canadian researchers, who reason that because “wives would be more likely than husbands to assume the caregiver role . . . the beneficial effect of marriage would therefore be stronger among men than among women.” Still, when the researchers turned their attention to divorced women, they determined that such women were more than four times as likely as single peers to delay the seeking of medical treatment after experiencing chest pain.

Overall, the researchers marvel at how markedly marital status affects the speed with which those suffering chest pain seek medical care. Indeed, they calculate that “the adjusted time saved” for a typical married person suffering chest pain compared to an unmarried peer suffering the same symptoms was “a remarkable half-hour.” “Among all the factors that had an effect in the primary outcome [statistical] model,” the researchers point out, “only calling an ambulance had a greater influence [than marital status] on the time to presentation.” Wearing a wedding band appears to be as important in dealing with a heart attack as does calling 911. Underscoring the importance of this medical benefit enjoyed by married individuals, the researchers comment, “Because cardiovascular disease is the most frequent cause of death in Canada and the Western world, the benefit at the population level is substantial.”

Whether in Minneapolis or Montreal, whether in the oncology ward or the cardiac unit, marriage means good medicine—and long life!

(Ray M. Merrill et al., “Unstaged Cancer in the United States: A Population-Based Study,” BMC Cancer 11 [September 21, 2011]: 402; Clare L. Atzema et al., “Effect of Marriage on Duration of Chest Pain Associated with Acute Myocardial Infarction Before Seeking Care,” Canadian Medical Association Journal 183.13 [September 20, 2011]: 1482–91.)

Trust is essential to a healthy society, economy, and political order. Without trust, relationships break down and the social fabric weakens. Yet a study conducted in Sweden by a public-health researcher suggests not only that marriage is a trust-booster but also that the retreat from marriage in Western nations, including the United States, places that essential social ingredient at risk.

Martin Lindström of Lund University in Malmö, Sweden, analyzed 2008 data from a public-health survey of more than 28,000 residents in southern Sweden to calculate the odds ratios of low levels of trust among their fellow Swedes, ages 18 to 80. In all three of his statistical models, including those that controlled for age, country of birth, educational attainment, economic stress, and emotional support, unmarried men—as well as divorced men—were significantly less likely to express trust in other people on a four-point scale (p<0.05 for all six coefficients), than were their peers who were married or cohabiting, living arrangements that the researchers unwisely grouped together into one category. These robust results were nearly identical for unmarried and divorced women, although the statistical significance of the correlation for divorced women in the third and final model disappeared.

While the blurring of married and cohabiting Swedes into one category represent a methodological weakness of the study, these findings nonetheless do constitute a significant addition to the “social trust” literature. As Lindström explains, the existing literature has centered on how trust affects children: “The family has often been regarded as an essential source for generating both social norms and trust among children and adolescents, and the relative decline of the traditional family as well as increased divorce rates in western countries have been regarded as major causes behind the ongoing successive decline in trust observed in the new birth cohorts as they reach adulthood in the USA.”

Now, however, the Swedish study quantifies how the family is essential for generating “social norms and trust” for adults as well.

(Martin Lindström, “Marital Status and Generalized Trust in Other People: A Population-Based Study,” forthcoming in The Social Science Journal.)

Stranded in painful loneliness by the low marriage rates and high divorce rates of modern life, a distressing number of men and women hit the bottle, hit it so hard, in fact, that many end up in an early grave. The grim linkage between singleness, alcohol abuse, and premature death stands out in a study by researchers at University College London, the University of Turku, and the University of Helsinki. Scrutinizing data from Statistics Finland for 18,200 alcohol-related deaths in Finland between 2000 and 2007, the researchers limn a clear relationship between alcohol-related deaths and social isolation.

The researchers report that compared to peers who are married or cohabiting (yes, this is twenty-first-century Scandinavia), single men and women are far more vulnerable to premature deaths related to the use of alcohol: the data indicate that for alcohol-related mortality, “crude death rates among individuals living alone were about 5-fold higher for men and 3-fold higher for women.”

Finns living alone became more vulnerable to lethal alcohol abuse in 2004, the researchers argue, when the price of liquor fell as a consequence of legal and economic changes. However, the data indicate that married men and women were far more resistant to life-ending alcohol abuse than were singles even before this drop in liquor prices. Looking specifically at liver disease (the most common reason for alcohol-related death), the researchers calculate an “age-adjusted risk ratio associated with living alone versus being married or cohabiting . . . [as] 3.7 before and 4.9 after the reduction in alcohol prices among men.” For Finnish women, the corresponding risk ratios were 1.7 and 2.4.

But liver disease counts as only one of the lethal consequences of alcohol abuse, and the researchers conclude that, quite aside from such disease, “Living alone was . . . associated with other mortality from alcohol-related diseases (range of risk ratios 2.3 to 8.0) as well as deaths from accidents and violence with alcohol as a contributing cause (risk ratios between 2.1 and 4.7), both before and after the price reduction.”

Though understandably disturbed by the consequences of cheaper liquor in Finland, the researchers recognize that the drop in liquor prices actually affected married Finns very little: “Among married or cohabiting people the increase in alcohol-related mortality was small or non-existent between the periods 2000–2003 and 2004–2007,” the researchers acknowledge, “whereas for those living alone, this increase was substantial, especially in men and women aged 50–69 y[ears].”

It is therefore no wonder that the researchers see in the upsurge of alcohol-related deaths a problem much bigger than that of liquor pricing. The larger problem manifesting itself through the spike in alcohol-related deaths is that “Social isolation and living alone are increasingly common in industrialised countries.” Such isolation, the researches explain, is inevitable in a world in which “fewer people live in extended families, and many delay and altogether avoid getting married and having children.”

Some public-health officials believe that they can deal with alcohol abuse by establishing more substance-abuse hotlines. But as this study clarifies, a root-and-branch solution requires a recovery of patterns that strengthen extended families and foster wedlock and child-bearing.

(Kimmo Herttua et al., “Living Alone and Alcohol-Related Mortality: A Population-Based Cohort Study from Finland,” PLoS Medicine 8.9 [September 20, 2011]: e1001094.)

As they contemplate the next few decades, public-health officials worry about an epidemic of suicide among the elderly. One such official, Debra Karch of the Centers for Disease Control and Prevention in Atlanta, recently noted that more than seven thousand Americans age 60 or older already commit suicide each year. And Karch warned, “As the population continues to age, the number of suicides by older adults is expected to climb as the ‘baby boomers’ reach older adulthood.”

To help her colleagues understand what social conditions aggravate this grim problem, Karch parsed suicide data from 2007 to 2009 from seventeen states (Alaska, California, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia and Wisconsin), representing 26 percent of the U.S. population. Her analysis gives reason to fear that the divorce revolution of the late-twentieth century will translate into an epidemic of elderly self-slaughter in the years ahead.

The data indicate that the unmarried are decidedly overrepresented among the older Americans who committed suicide during the study period. Almost half of men (47 percent) and almost two-thirds (63 percent) of women who committed suicide were divorced, single, or widowed. Thus, marital status turns out to be a highly significant predictor of suicide among older Americans of both sexes (p<0.001).

In her findings, Karch sees “a challenge for the field of public health,” as officials strive “to identify which of the many potential strategies are the most effective for suicide prevention among older adult males and for females.” To this end, Karch suggests measures such as “reducing the stigma of seeking care for mental health and substance abuse problems, . . . [and] reducing access to lethal means.” But anyone who can read her findings will see the urgent need to slow the traffic into the nation’s divorce courts and to increase the traffic into its wedding chapels.

(Debra Karch, “Sex Differences in Suicide Incident Characteristics and Circumstances among Older Adults: Surveillance Data from the National Violent Death Reporting System: 17 U.S. States, 2007–2009,” International Journal of Environmental Research and Public Health 8.8 [August 23, 2011]: 3479–95.)

Public-health officials are in a near panic over the dramatic rise in childhood obesity. However, a study by researchers at Bowling Green State University seems to indicate that it is past time for these officials to start worrying about the rise in full-time maternal employment and the fall in marital fertility as prime causes of the epidemic in childhood obesity.

To be sure, obesity rates among children have jumped off the charts since 1980. The Bowling Green scholars begin their study highlighting the fact that “the prevalence of overweight and at-risk for overweight children [has] quadrupled” since 1985. This spike in childhood obesity particularly troubles the researchers because they recognize that “those who experience early onset weight gain are more likely to be heavier later in adulthood than children with later onset.” Since obese adults are particularly vulnerable to Type-2 diabetes and to heart trouble, health officials have good reason to worry about the increasing prevalence of childhood obesity.

To determine the social circumstances which foster childhood obesity, the researchers analyzed data collected from a national representative sample of children whose Body Mass Index was first measured in kindergarten and then re-measured in first, third, fifth, and eighth grades. Some of the findings coming out of the researchers’ analysis of these data are uncontroversial—even unremarkable. That children who watch a great deal of television tend to be overweight will surprise no one. Nor will it astound anyone that children who are particularly heavy at birth tend to be overweight in later childhood. Likewise rather predictable is the finding that children with less educated parents tend to be heavier. Even the finding that children growing up in the Northeast are heavier than children in other regions of the country is unsurprising given the heavily urban character of that part of the country.

But two findings are sure to provoke controversy because they highlight the ways that recent changes in American family life have fattened up a generation of children. One of the provocative findings of the new study is that “having a full time working mother” emerged as a statistical predictor that a child (male or female) would be classified as “always overweight.” The other provocative finding was that “having more children in the household reduces the risk of sustained overweight.” These two findings are clearly interrelated, given that maternal employment drives down completed fertility and thus figures as a prime reason for the sharp drop in marital fertility in recent decades.

Understandably, the researchers conclude by suggesting that public-health officials should give “more concerted attention” to the “serious condition of sustained overweight, characterized by practicing sedentary behaviors such as television viewing, possessing an above average birth weight and having a mother who works full time.” Given the way that academics and media pundits have made maternal employment and the retreat from childbearing immune from even the slightest criticism, these officials may face a stiff challenge in addressing the root causes of childhood obesity.

(K. S. Balistreri and J. Van Hook, “Trajectories of Overweight among U.S. School Children: A Focus on Social and Economic Characteristics,” Maternal and Child Health Journal 15.5 [July 2011]: 610–19).

The evidences continues to mount that African Americans, like all Americans, have more to gain from life-long marriage than from cohabitation, divorce, or the single life. The latest contribution to the literature comes from public-health researchers at the University of Maryland and Johns Hopkins University, researchers that discovered that African-American living in urban settings who are married are significantly less likely, compared to their unmarried peers, to engage in binge drinking, to smoke cigarettes, and to use illegal drugs. Moreover, the Maryland scholars suggest that their findings, which were controlled for marriage-selection effects, confirm that African Americans suffer poorer health than white Americans in part because of their lower marriage rates.

Kerry Green and her colleagues examined longitudinal data representing 546 women and 503 men who participated in the Woodlawn Study, an epidemiological study that tracked African Americans, from ages 6 to 42, living on the South Side of Chicago, beginning in the 1960s. After identifying six subgroups based upon marital status, the researchers conducted regression analyses to measure the likelihood of members of the respective subgroups, or marital “trajectories,” to engage in behavioral-health risks, including the leading cause (tobacco use) and third leading cause (alcohol consumption) of death in the United States.

Both men and women in the three unmarried subgroups were found to be distinctively likely to engage in the three risk behaviors at young adulthood (age 32) as well as at midlife (age 42). Likewise, men and women in the three married subgroups were distinctively unlikely to engage in risk behaviors.

Further analysis established that, compared to their peers that had remained continuously married, both African-American men and women that had married and divorced prior to age 32 faced the same odds of risky behavior in young adulthood as did their peers that had never married. (Five of the six odds ratios for women in both unmarried categories reached statistical significance; among men, three of the six reached statistical significance.) Similar patterns were replicated among both men and women who had married and divorced prior to age 42.

These findings may not be all that surprising, yet they lead the public-health experts to state the obvious: “The benefits of marriage only translate to those individuals who remain continuously married.” At the same time, the researchers—all of whom are women—lament that many African Americans are not benefiting from “marriage protection,” as only “a little more than a third” of their sample were married at midlife. Indeed, the Green team even sees promise in social policies, dating back to the George W. Bush era, that promote healthy and stable marriages while calling for a rethinking of other welfare policies “that may unintentionally discourage marriage among low-income populations.”

(Kerry M. Green et al., “Marriage Trajectories and Health Risk Behaviors Among Urban African Americans,” forthcoming in Journal of Family Issues.)

Maternal death in childbirth is relatively rare in twenty-first-century America. Yet American mothers still die in childbirth in the United States (recent reports indicating that the maternal mortality rate in childbirth in the U.S. has actually risen sharply from 11 per 100,00 in 1995 to 24 per 100,000 births in 2008), and mothers in other countries die in childbirth much more often. In fact, when an international team of American, Swiss, and British researchers recently set out to study the problem, they estimated that, globally, “approximately one-third of a million women die each year from pregnancy-related conditions.”

To understand more fully the circumstances under which these tragic deaths occur, the researchers examined data for 287,035 inpatients giving birth in 2004 or 2005 in 373 health-care institutions in twenty-four countries in Africa, Asia and Latin America. In their analysis, the researchers emphasized the inverse relationship between maternal education and maternal mortality: well-educated women are significantly less likely to die in childbirth than poorly educated women. However, their research also highlighted other social circumstances that elevate the risk of maternal mortality in childbirth. For instance, statistical analysis reveals that women who are unmarried or cohabiting face a risk of childbirth death that runs 60 percent higher than do married peers (odds ratio, 1.60).

What is more, the data identify a markedly elevated mortality risk for women giving birth over the age of 35 (as is increasingly the case in the United States, where many women are postponing childbearing to pursue career and educational goals). Compared to younger mothers, women over the age of 35 run an almost 80 percent higher risk of childbirth death (odds ratio, 1.79).

In interpreting their findings, the researchers acknowledge that progress in reducing maternal mortality “depends on widespread improvements in the level and quality of antenatal and obstetric facilities in developing countries.” But these researchers appropriately warn against “an exclusive focus on medical and technological approaches” to the problem, cautioning against the error of “overlooking the critical contribution of societal conditions to health.” “More attention,” they write, “should be given to the wider social determinants of health, including education, . . . to reduce maternal mortality.”

Of course, as they seek to reduce maternal deaths in childbirth, public officials should remove obstacles to women’s education. However, this study makes clear the real peril in social developments that cause women to avoid marriage or postpone childbearing.

(“Maternal Mortality Ratio per 100,000 Live Births,” Millennium Goals Indicators, United Nations Statistics Division, <http://unstats.un.org/unsd/mdg/Metadata.aspx?IndicatorId=0&SeriesId=553>; Saffron Karlsen et al., “The Relationship Between Maternal Education and Mortality Among Women Giving Birth in Health Care Institutions: Analysis of the Cross Sectional WHO Global Survey on Maternal and Perinatal Health,” BMC Public Health 11 [July 29, 2011]: 606.)

Around the world, married men and women enjoy a decided advantage in mental health. More particularly, research indicates that in both wealthy and developing countries married individuals are far less vulnerable to depression than their unmarried peers.

To identify the social contexts in which men and women are most likely to suffer a Major Depressive Episode (MDE), a large international team of American, Australian, Latin American, European, and Asian scholars pored over psychological data collected from ten high-income countries (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, United States) and eight low- to middle-income countries (Brazil [São Paulo], Colombia, India [Pondicherry], China [Shenzhen], Lebanon, Mexico, South Africa, Ukraine). These researchers report, “MDE prevalence estimates varied considerably between countries, with the highest prevalence estimates found in some of the wealthiest countries in the world.” Further analysis highlights the importance of an intact marriage in shielding couples against depression and of marital failure in exposing men and women to such mental illness.

“Marital status,” remark the researchers, “was a consistently significant correlate of MDE.” More particularly, the researchers find a statistically significant elevation of the risk of MDE for men and women who were separated from a spouse (as opposed to those in intact marriages) in twelve of the countries surveyed, with odds ratios (ORs) in these countries ranging from less than 4.0 in five countries to over 8.0 in India, Japan, and Lebanon. The researchers identified a statistically significant elevation of the risk of MDE among men and women who were divorced in seven of the ten developed countries studied and in a four of the eight developing countries, with unusually high ORs in Japan (OR = 5.1), China (OR = 6.2) and Ukraine (OR = 4.2). Interestingly, the researchers report, “Being widowed was less consistently and more modestly associated with MDE.” In other words, losing a spouse through divorce or legal separation is more likely to plunge a person into depression than is losing a spouse through death.

Of course, only those who have had a spouse can lose a spouse. And the researchers find that “in the high-income countries [in the study], there was a significantly increased OR of MDE among the never married.” That is, never-married men and women—like their divorced and separated peers—face a risk of serious depression significantly higher than that found among married peers.

Looking specifically at the United States, the researchers find that, when compared to peers in intact marriages, separated men and women are 300 percent more likely to suffer an episode of major depression, divorced men and women are 70 percent more likely, and the never married are 80 percent more likely (odds ratios of 4.0, 1.7. and 1.8; p<0.05 for all three comparisons).

The researchers conclude that episodes of major depression constitute a “significant public-health concern across all regions of the world” and that such depression is “strongly linked to social conditions.” This international team of scholars calls for “future research . . . to investigate the combination of demographic risk factors that are most strongly associated with MDE.” But the results that have already returned indicate that enduring wedlock is a strong antidote to the social conditions that incubate depression.

(Evelyn Bromet et al., “Cross-National Epidemiology of DSM-IV Major Depressive Episode,” BMC Medicine 9 [July 26, 2011]: 90.)

Alarmed by the consequences of low fertility, policymakers in many developed countries have struggled to find ways to reverse the dynamics of de-population. A study in the Netherlands suggests that getting grandparents involved in caring for their grandchildren holds promise in increasing the number of those grandchildren.

Evidently concerned about “low birth rates in developed societies,” a team of researchers at Vrije Universiteit Amsterdam (VUA) set about investigating the issue. After all, they point out, “societies with low fertility face the risk of a shrinking working population” and, as a consequence, have reason to worry about “the sustainability of collective pension, social insurance, and care systems.”

These worried scholars begin their research with doubts about whether their colleagues were looking at the right issue in focusing on “the role of formal childcare” in helping women combine employment and motherhood. “Evolutionary theory points to the importance of kin,” these scholars assert, invoking a “cooperative breeding hypothesis” that emphasizes the way “the wider kin group has facilitated women’s reproduction during our evolutionary history.” These researchers see the critical role the wider kin network has played in supporting reproduction in pre-industrial societies, but acknowledge the lack of “direct evidence of beneficial effects of kin’s support on parents’ reproduction in modern societies.”

Such evidence emerges, however, from the VUA researchers’ careful scrutiny of data collected in two rounds of surveys between 2000 and 2002 from a nationally representative sample of Dutch men and women ages 54 to 84. These data clearly indicate that “childcare support from grandparents increases the probability that parents have additional children in the next 8 to 10 years.”

The fertility-enhancing effect of grandparental involvement in caring for grandchildren is quite pronounced. The researchers calculate that, with typical background variables, the child who is not cared for by grandparents would only see an addition to his family during the eight-to-ten-year period of interest in 35 percent of the cases. In contrast, the child who is cared for by grandparents would see an addition to his family in 66 percent of the cases.

In commenting on the fertility-enhancing effect of grandparental child care, the researchers reason that “in addition to providing practical support, such as childcare, grandparents can also encourage their children to reproduce. Grandparents can communicate that they would welcome grandchildren, and that they would like their children to become parents. Such normative social influence may also have a positive effect on the fertility of the children.”

The plausibility of such reasoning grows stronger in light of a prior study establishing that a German woman is more likely to bear a child if she lives in the same town as her parents than if she does not. Likewise supportive of this thinking is an Italian study showing that women have higher fertility if their parents are still living than if they are not.

The Dutch researchers further interpret their findings as support for neo-Darwinian theorizing, suggesting that the reason that “grandparents . . . enhance the reproductive success of their children” is that “relatives share common genes by descent.” Such common genes give biological logic to “natural selection . . . favor[ing] genes that enable individuals to help their relatives to reproduce successfully.” American readers may demur on the neo-Darwinian logic. But the power of extended family to foster fertility is very clear.

(Ralf Kaptijn et al., “How Grandparents Matter: Support for the Cooperative Breeding Hypothesis in a Contemporary Dutch Population,” Human Nature 21.4 [December 2010]: 393–405.)

For decades, the empirical literature has confirmed that children raised by their married parents do significantly better, on average, than their peers reared by unwed or single parents. That verdict, however, has not persuaded all social scientists, some of whom claim the law of averages does not necessarily apply to those at the lower end of the income scale, particularly when parents marry after an out-of-wedlock birth. But in a dataset from the Fragile Families and Child Wellbeing Study, which represents exactly this subpopulation, two economists uncover new evidence that yes, parental marriage improves a child’s cognitive outcomes, even when that marriage occurs after the child’s birth.

Examining data on 958 children born between 1998 and 2000 to romantically involved but unmarried parents, Shirley Liu of the University of Miami and Frank Heiland of Baruch College investigated the effects of parental marriage after childbirth on child outcomes at age 3. While they found no evidence that parental marriage affects a child’s risk of developing asthma or behavior problems, the economists determined that parental marriage significantly increases a child’s cognitive development, as measured by the Peabody Picture Vocabulary Test.

The merit of the study is Liu and Heiland’s “potential outcome” methodology that accounts for parental self-selection into marriage, which allows a true comparison between children, according to the researchers, “who share similar parental background characteristics and assortative mating patterns who differ only in terms of whether their parents marry or not.” Consequently, the economic team estimates the effects of parental marriage after childbirth on child cognitive ability using a several ordinary-least squares (OLS) regressions as well as propensity-score matching estimates.

Out-of-wedlock children whose parents married scored 3.1 points higher on the Peabody test than did their peers whose parents failed to tie the knot. The effect was reduced to 2.2 points in OLS regressions that controlled for a full set of covariates, yet the correlation remained statistically significant (p<0.05). In the propensity-score matching analysis, the researchers found that parental marriage increased the child’s Peabody test scores between 3.5 and 4.4 points (a quarter of a standard deviation) over what those scores would have been had the same parents remained unmarried. Liu and Heiland also discovered that the effects of parental marriage on child development did not accrue to children when parents cohabited outside of marriage.

These enhanced scores for the children of parents who married may not seem significant. But according to the researchers, who used correlations from data from the National Longitudinal Survey of Youth as a baseline, a four-point increase in the Peabody test at age 3 “may raise the odds of high school graduation by 2 percentage points.”

Given what the economists deem are “particularly large gains from marriage,” what might encourage more unwed parents to marry? In their analysis, the researchers found that couples who “face a greater stigma of out-of-wedlock childrearing and those who are less similar in terms of their educational attainments are more likely to transition into marriage after childbirth.” The latter finding may surprise, yet it confirms that wedlock continues to facilitate—even among the low-income population where one spouse has less formal education than the other—specialization in home and market, allowing husband and wife to better allocate time and material resources to their children.

(Shirley H. Liu and Frank Heiland, “Should We Get Married? The Wedlock Effect of Parents’ Marriage on Out-of-Wedlock Children,” Economic Inquiry 50.1 [January 2012]: 17–38.)