Hard times on the road to adulthood

In the journal Future of Children, Sheldon Danziger and David Ratner review changes in labor market conditions that have altered the road to adulthood:

“…changes in the labor market over the past thirty-five years, such as labor-saving technological changes, increased globalization, declining unionization, and the failure of the minimum wage to keep up with inflation, have made it more difficult for young adults to attain the economic stability and self-sufficiency that are important markers of the transition to adulthood. Young men with no more than a high school degree have difficulty earning enough to support a family. Even though young women have achieved gains in earnings, employment, and schooling relative to men in recent decades, those without a college degree also struggle to achieve economic stability and self-sufficiency.”

That’s the hard times angle. But the review also shows a number of ways that labor market circumstances have improved for young women. Some of those gains look especially good relative to men, who have lost ground, as in the case of the percentage of men versus women working for less than $9/hour in 2007 dollars (more than the national minimum wage in 1979, less than a poverty wage for a family today):

The improvements are greatest for White women, and the situation is worst for Latino men (note, people without jobs aren’t included in this graph). But the pattern is similar across race-ethnic groups: worse for men, better for women, at the bottom of the market.

The implication many have drawn from these trends is that the improved job situation for women, relative to men, explains the decline in marriage and the rise in single mother families. They remind us, however, that research has not been able to establish that link. It is true that men with job problems are less likely to marry, but that can’t explain the whole increase in the age people marry or have children outside marriage, and the trends in marriage and childbearing are similar up and down the labor market spectrum.

Unhealthy behavior?

The latest QuickStats from the CDC is titled, “Prevalence of Selected Unhealthy Behavior Characteristics Among Adults Aged ≥18 Years, by Race — National Health Interview Survey, United States, 2005–2007.”

What is an “unhealthy behavior characteristic?” I can see smoking and drinking, and maybe physically inactive, but obesity and sleep deprivation seem like health conditions resulting from a number of factors — like access to healthy food, working conditions, living conditions, family size, other health conditions, etc. — only some of which are behavior, or at least behavioral in origin. Maybe this is a public health nuance I’m not familiar with.

Anyway, the differences are interesting.

Children’s extreme health inequality

A new systematic review of hundreds of research studies finds pervasive inequality by race/ethnicity in health and health care among children in the U.S. The report, by Glenn Flores and the Committee on Pediatric Research, was published online by the journal Pediatrics.

After collecting more than 700 articles, they selected 111 that met their review criteria. Their conclusion:

Disparities were noted across the spectrum of health and health care, including in mortality rates, access to care and use of services, prevention and population health, health status, adolescent health, chronic diseases, special health care needs, quality of care, and organ transplantation. Mortality-rate disparities were noted for children in all 4 major US racial/ethnic minority groups, including substantially greater risks than white children of all-cause mortality; death from drowning, from acute lymphoblastic leukemia, and after congenital heart defect surgery; and an earlier median age at death for those with Down syndrome and congenital heart defects.
And that’s a short list of the disparities uncovered. Some of the more shocking disparities are in things I never considered. Take the age at death for people with Down syndrome. There has been dramatic improvement in life expectancy in this group, who used to die on average before age 5. By the early 1990s survival for Whites had surpassed age 40 — but it was still under 10 for Blacks. By the late 1990s, the White survival was still twice as long as that for African Americans.
The studies are all detailed and referenced in the article. Almost 80% of the studies reviewed included statistical adjustments to help rule out confounding factors. However, it’s important to remember that race/ethnic disparities don’t have to be caused by race/ethnicity in order to be socially or morally wrong. Even if the inequality is caused by poverty, living in polluted areas, blocked access to health care, worse health behavior by parents, or unknown causes — the observed inequality is still real life for the children affected.

Breastfeeding gaps persist

The American Academy of Pediatrics recommends nothing but breast milk for the first six months of life, and continued breastfeeding for 12 months, when possible. The Federal and state governments have set these as public health goals. However, the achievement of these goals is unequally distributed according to race/ethnicity and education level, according to a new report.

This is not just a matter of awareness, although that is part of the story. Among the many barriers to breastfeeding are the potential problems for working moms, and the fact that only some places protect mothers’ right to breastfeed in public.

There are many sources of support for breastfeeding, for sure.  But maybe it would catch on more if people could post their pictures on Facebook, or if people got the breasfeeding doll for their daughters:

Gay rights birthright

Washington D.C.’s Council has given final approval to a gay marriage bill and the mayor has signed it, so it now just requires Congress to ignore it for the law to take effect. Earlier, I wrote that universal civil rights is a good case of the need to protect the minority from the majority, using legislatures and courts rather than referendums.

As I’ve been reading about the history of sexual identities, I was drawn into the origins of sexual orientation (sum: not much known). There was an exchange from the D.C. debate, which pitted an older generation of Black civil rights activists (such as Marion Barry), who oppose the analogy between gay and Black rights struggles, and a younger generation that supports gay rights.

Kwame Brown (D-At Large) supports gay marriage, seeing it as the next chapter in the fight for equality. But his father, a political campaign consultant in the city, bristles when the drive for same-sex marriage is compared with the civil rights movement.

“You can choose to be gay or not,” Marshall Brown said. “You can never choose to be black or not.”

Not so, his son said. “People are born that way,” Kwame Brown said.

(This racial angle shouldn’t be exaggerated, as two Black pastors testify.)

It’s really not just “born that way” versus a “choice,” of course, because, as United Families (which opposes gay rights) puts it, “Predisposition toward something does not mean that it is inevitable…” which is true, though the second half of the sentence is gratuitous: “…or that such a predisposition cannot or should not be resisted and overcome.” Nevertheless, the “born that way” claim is the Number 1 “myth” they feel the need to dispel.

And that’s not an accident. It turns out that the “strongest predictor” of positive views toward gays and lesbians, and policies that support them, is the view that homosexuality is something people are “born with.” A study by Haider-Markel and Joslyn tested an “attribution theory of controllability.”

If the cause of homosexuality is perceived as controllable (learned, environmental, or an individual choice), negative affect toward homosexuals and reduced support for policies relevant to the group can be expected. If the cause is perceived as uncontrollable (biological or genetic in origin), positive affect and increased support for polices is anticipated.

In their data about a third of people agreed that, “when a person is homosexual,” it is “something that people are born with.” Sure enough:

Our analyses of data from two unique surveys of national adults corroborate these hypotheses, showing that positive feelings toward gays, support for gay civil rights, civil unions, and same-sex marriage are strongly determined by a genetic attribution for homosexuality. Attributions are in fact the strongest predictor of support.

The civil rights movement for African Americans didn’t base its moral claims on the idea that people don’t “choose” to be Black. I don’t know enough history of the gay rights movement to make the parallel all the way through. But it seems to me this tendency among the public reflects the stigmatized status of homosexuality – not something the movement wants to hang its hat on, even if it’s true.

Teaching too late

Even when parents make an effort to talk to their kids about sex, adolescents’ sexual experience is often a step ahead of them. Apart from its emotional consequences, the health implications of this disconnect are serious, and seriously unequally distributed.

A new study in Pediatrics shows that by the time many parents talk to their children about sex, they’ve already had sex. The exact numbers aren’t important because the sample was not representative, but more than a third of children had already had intercourse before their parents discussed many sex specifics with them: how to identity sexually transmitted disease symptoms, how to use a condom, how to choose a method of birth control, or what to do if a partner refused to use a condom (in the case of girls).

FYI, the government’s National Survey of Family Growth from NSFG in 2002 found that 30% of girls have had sex at age 16, 46% at age 17, and 67% at age 18.

Given that the majority is having sex before leaving high school, you might wish that schools would provide that kind of information – which they sometimes do.

But it’s not getting through to enough kids in time, as we learn from another study – this one nationally representative. It shows that, among female teenagers who reported having had sex, 38% had at least one sexually transmitted infection. The most common (30%) was human papillomavirus (HPV), which clears up harmlessly on its own in most cases. But in about 10% of cases persists, and increases the risk of cervical cancer.

(There is an HPV vaccine recommended for all girls by the federal government’s advisory committee, before they have sex for the first time. But many parents and abstinence-only proponents have opposed the vaccine, and laws providing for it, on the imagined grounds that it will encourage irresponsible sexual behavior. And, because parents’ rights trump children’s rights, the vaccine requirements proposed in some states have a parental op-out provision.)

The study also shows the teenagers’ prevalence of chlamydia (7.1%), trichomonas (3.6%), gonorrhea (2.5%), and herpes (type 2, 3.4%). Although these are curable or treatable in most cases, they do increase the risk of contracting HIV.

The lack of information or other resources necessary to protect young women’s health is, not surprisingly, concentrated among poor and minority – especially African American – women. Black adolescents are about twice as likely as Whites or Mexican Americans to have any STI (44% versus 19% and 18% respectively); and those below the poverty line had almost twice the rate of those above (34% versus 19%). This is partly because these groups are more likely to have had sex or more partners, but the race difference persisted when those factors were controlled.

To overcome the problem of sexually transmitted infection, and the disparities in its distribution, will require both real sex education and health coverage that includes vaccination, screening and other services.

Latina teen suicide

A small story about a young young woman, Cecilia Casas, apparently committing suicide on a Los Angeles freeway the other day led me to refresh myself on gender, ethnicity and suicide.

CNN did a story in October about Latinas in particular, with some statistics and interviews. More generally, a recent review in the journal Aggression and Violent Behavior showed that among young adults in all race-ethnic groups, women are more likely to attempt suicide than men:

One-year percentages of suicide attempts among 10–24 year olds. Gender ratios (males:females) are presented below each group.

…but men are much more likely to succeed.

One-year rates of suicide deaths per 100,000 among 10–24 year olds from 1999 to 2005. Note. Gender ratios (males:females) are presented below each group.

Suicide attempts are going to be counted much less accurately than completed suicides, so reconciling these is not simple. However, mental health data on teenagers shows that girls are much more likely than boys to have major depressive episodes:


On consequence of the attempt/completion ratio difference between men and women is that mental health practitioners are better able to intervene with women, since they’re more likely to have an unsuccessful attempt as a trigger for treatment. It’s not as effective to rely on self-reported suicidal thoughts, which is more often necessary with men. In any case, access to regular medical care – a usual doctor or other provider, not an emergency room – seems like a necessary condition for identifying and preventing suicide.

Coincidentally, Dr. Perri Klass has a post today – with good links to resources – about how to handle depression and suicidal thoughts in a discussion with students.

What ails Black women 2: Health and life

The employment and wage disparities now widening between Black and White women appear alongside substantial – and possibly increasing – health disparities. As the recent concern over breast cancer advice shows, Black and White women often inhabit different worlds in our healthcare system.

Consider the infant mortality rate, a good measure of women’s health and healthcare. The Black infant mortality rate (13.63) is 2.4-times the White rate overall of 5.76 (a shade worse than 10 years ago). Teen motherhood doesn’t explain this, as the race gap is actually smallest for mothers under age 20 – if there were more Black teen mothers, the overall gap would be smaller.

Source: National Vital Statistics Report (2005 data).

Even controlling for income, education, obesity, smoking, and some diseases, Black infant mortality is significantly higher. This presumably indicates worse healthcare, although some suspect the “physiologic effects of experiencing lifelong racism.”

The most striking of the recent reports was a scary analysis released earlier this year showing that Black women have been getting shorter: absolutely and relative to White women, and the same is not true of Black men.

Height within a group varies according to genetics, but height differences between groups indicate health and nutrition inequalities during childhood. Black women born in 1965 reached an average height of 5’4-1/2” (Michelle Obama is about 5’11”). Each cohort since then has been shorter, and the average for those born in 1980 is less than 5’4”. Black men and White men and women all grew taller during this period. Black men and White men are now separated by less than a quarter inch, but White women have opened up a gap of three-quarters of an inch.

The author of the analysis, John Komlos, believes obesity is the main factor driving the disparity, compounded by inequities in health care access and quality. He concludes:

The decline in [Black women’s] height is most likely related to the obesity epidemic caused by inadequate dietary balance. Black women in the age range 20-39 weigh some 9.5 kg (21.0 lb) more than their white counterparts. It appears that black females are experiencing a double jeopardy in the sense that both their increasing weight and the diminution of their physical stature are both substantial and are both probably associated with negative health consequences.

In some urban areas, the disparities between Black and White women are especially stark. That is the case in Washington, D.C., which pairs a disproportionately poor Black population with an above-average-income White population. There, Black women are more than 3-times more likely to be overweight or obese than Latina or Asian women, 5-times more likely than White women.

Obesity doesn’t explain everything, of course, and neither does other health behavior such as smoking. At just 17.3%, Black women have lower smoking rates than White women (21.5%).

Racism and discrimination are the hard-to-measure elephants in the room on both employment and health matters. That’s coming in the next entry.

Before: Work and wages

Today: Health and life

Next: Discrimination and repercussions

What ails Black women 1: Work and wages

In both the current situation (the recession) and in the medium run (the last few decades), Black women are losing ground – relative to Whites, and in some cases absolutely. What is going on?

Life not at the top


Back during the presidential campaign, I suggested that Barack Obama’s success didn’t mean the average Black person in America was doing better than before: “What happens at the tails of the distribution – out at the extremes, where the fastest people run, and the most successful minorities thrive – is not a good measure of what’s happening at the middle of the distribution, where the average is found.” Today there is a tendency to use Michelle Obama as a symbol for Black women’s progress. Even The Government does this, as in, “Michelle Obama Presents Modern Image for Black Women,” which celebrates how her “combination of her professional and domestic success challenges stereotypical media images of black women in America.”

But below the top of the distribution, things are not going as well.

Work and wages

We’ve known for months that men are losing a lot more jobs than women in this recession. And, of course, it has cost Blacks more than Whites. But as I reported the other day, the Black-White gap in job losses is greater among women. Specifically, Black women have lost 5.2% of their jobs in the year ending October 2009, while White women lost 2.5%. That’s a ratio of 2.1:1. Among men, the Black-White loss ratio was “only” 1.5:1. For the first time in a long time, White women are more likely to have jobs than Black women. (All this is based on non-institutionalized civilians ages 20+.)

pct employedSource: My chart from BLS data.

This divergence in the last year follows a longer trend of increasing wage inequality between Black and White women, thoroughly investigated in, “Employment Gains and Wage Declines: The Erosion of Black Women’s Relative Wages Since 1980,” by Becky Pettit and Stephanie Ewert in the latest issue of Demography. In the late 1970s, White women’s wages were less than 5% more than Black women’s, and they are now more than 10% higher – closer to 15% higher for young workers.


Why are Black women falling further behind? After an in-depth statistical analysis, they conclude:

Despite decades of educational expansion, employed black women continue to lag behind employed whites in the educational qualifications that are increasingly relevant in the contemporary workplace. Premarket educational inequalities are magnified by a labor market that increasingly rewards education. Widening racial gaps in marriage—combined with growing returns to marriage—also disadvantage African American women. These factors, combined with a retreat from affirmative action programs and weak enforcement of employment discrimination law, may have uniquely disadvantaged the economic fortunes of black women.

Success at the top may bring benefits to those who recognize or celebrate it. But it shouldn’t be confused with success for everyone else.

A series

Today: Work and wages

Next: Health and life

Then: Discrimination and repercussions

Black v. White women’s employment losses

Data from the BLS today show Black women losing almost twice as much as White women in terms of percent of each group employed. From October 2008 to October 2009, the percentage of White women employed fell from 57.6% to 55.7%. For Black women the fall was from 58.5% to 54.8%. The change is shown here:

change in emp-pop ratio oct08-oct-09_26060_image001

Source: My calculation from Bureau of Labor Statistics.

Coming soon, more on the declining relative status of Black women.