Submitted in response to Health Canada's request for proposal on Health Impact of Economic Change
William Avison, Lorraine Davies, Rajulton Fernando,
Don Kerr, Robert Andersen, and Zenaida R. Ravanera
This project aims at a better understanding of the influences of families and communities on population and individual health of Canadians, and takes advantage of an earlier SSHRC-funded project on Family Transformation and Social Cohesion. A joint undertaking of University of Western Ontario's Population Studies Centre and Centre for Health and Well-Being, the project will examine the health impact of changes in socio-economic positions of families at various life course stages, and explore the ways through which families and communities influence health outcomes, behaviours, and practices. Appropriate cross-sectional, longitudinal and multi-level statistical techniques of analysis will be performed on existing data including the 1998 General Social Survey (GSS) on Time Use, the 2001 GSS on the Family, the National Population Health Surveys, the National Longitudinal Survey on Children and Youth, the Canadian Community Health Survey, and the Participation and Activity Limitation Survey.
The proposed research will cover a number of relationships or pathways indicated in the project's framework which assumes that multi-level influences on health occur over the life course. The first set of studies - Family formation, fertility and health - would seek to understand the relations between the conditions of the parental family and the individual socio-economic situations. The second set - Family structure, economic security, and health over the life course - would examine the interplay between changes in the economic situations, the family, and health of children and adults. Both sets would take into account the community contexts. The final group of studies - Community, social cohesion and health - would look more closely at the health impact of communities including their economic condition and social cohesion.
An important element of the project is the examination of the impact of community characteristics on the health of Canadians. The inclusion of communities in the analysis would depend on the merging of data from the surveys with data on communities derived from the censuses.
I. General Objectives:
The project proposes to analyze the relationships between health gradients and the socio-economic positions of families and communities, to examine the impact of changes in families on the health of Canadians at various life course stages, and to explore the ways through which families influence health outcomes, behaviours and practices. This joint project of two research centres at the University of Western Ontario - The Population Studies Centre and The Centre for Health and Well-Being - will build on the research done under the Family Transformation and Social Cohesion Project. Existing data will be utilized including the General Social Surveys merged with data on communities derived from the 1996 census, the National Population Health Surveys, the National Longitudinal Surveys on Children and Youth, the Canadian Community Health Survey, and the Participation and Activity Limitation Survey.
That there is association between individual's health status and socio-economic position has been recognized for centuries (Lynch and Kaplan, 2000 and citations therein; Ross and Mirowsky, 1999, Mirowsky and Ross, 1998). It is also apparent and documented by several studies (see for example, Marmot and Wilkinson, 1999; Berkman and Kawachi, 2000) that the environment, including its economic and social conditions, influences both the population and individual health.
This project assumes that families play an important role in mediating the effects on health of socioeconomic status of individuals and communities although, as Emmons (2000) notes, to date relatively little is known about the influences of family on health behaviours and how these influences operate at different life course stages (p.252).
Examining the relations between families and health becomes even more important when seen in the light of recent macro and micro level changes. At the macro-level, major social changes like globalization and expanded role for markets have put a stress on social cohesion or require that societies establish new forms of cohesion. At the micro level, families have changed in ways that have affected both the cohesiveness of families and the way in which families play roles in people's belonging to a shared community. Over the past four decades, Canadian families have been transformed through increasing popularity of cohabitation and high rates of separation and divorce, low fertility reflected in fewer children per family and high rates of childlessness, greater number of lone parent families, dramatic increase in labour force participation particularly of married women, and the later ages at experience of life course events. A significant part of the new internal context is associated with family changes that bring a new kind of insecurity. That is, the insecurities associated with death, orphanhood and widowhood are replaced with insecurities in marital and parental relationships (Beaujot and Ravanera, 2001).
The people who will undertake this study include researchers involved in examining the relationship between family transformation and social cohesion. This proposed project would build on the research done on family transformation in order to understand how families impact on health in the context of economic and social changes at the macro and micro levels.
III. Analytical Framework and Research Topics / Questions
The proposed research will cover a number of relationships or pathways indicated in the framework (see Figure 1), which assumes that multi-level influences on health occur over the life course. The first set of studies - Family formation, fertility and health - would seek to understand the relations between the conditions of the parental family and the individual socio-economic situations including those brought about by family formation and dissolution (arrows 1, 2, and 3 in Figure 1). The second set - Family structure, economic security, and health over the life course - would examine the interplay between changes in the economic situations, the family, and health of children and adults (4, 5, 6, and 7). The final group of studies - Community, social cohesion and health - would look more closely at the health impact of communities including their economic condition and social cohesion (8, 9, and 10).
The studies will mostly make use of longitudinal data collected through Statistics Canada. The three (or four waves) of surveys will not allow analysis over the whole life course, but they would be of much use in the analysis of major transitions and changes that have occurred over a period of 6 to 8 years in the lives of Canadians. Whenever possible, community level data derived from other sources will be included in multi-level analysis.
The research questions, enumerated below for each type of research, are expected to have both direct and indirect relevance to health policies. They will also be relevant to policies related to families, education, and welfare, which have indirect impact on population and individual health.
A. Family formation, fertility, and health
On family formation - The influence on health of socio-economic conditions occurs at different stages of the life course starting from pre-natal stage. A low socio-economic position of mothers, for example, could affect the intra-uterine condition leading to low birth weight that is associated with a range of health outcomes from childhood to old age (Drever and Whitehead, 1997; Blane, D., 1999; Lynch and Kaplan, 2000). Thus, analysis of factors affecting family formation and other conditions leading to parenthood is an appropriate prelude to understanding the relations between health and economic change.
Starting from the 1980s, young Canadians have delayed their transition to adulthood. In comparison to their parents, young adults complete schooling, start regular work, leave the parental homes, and start marriage and parenthood at older ages (Ravanera, Rajulton, and Burch, 1998; Ravanera et al, 2002). While this could be viewed as putting a "generation on hold" (Cote and Allahar, 1994), this delay could also be seen as a strategy to cope with greater risks created by globalization. The young seek to minimize these risks by investing in human capital B they invest in themselves before they invest in reproduction. This also allows greater parental investment as resource flows from parents are stronger within households than across households (Beaujot, 2000).
But, while the general trend is to postpone family formation, there are variations by socio-economic positions - those with lower parental and personal resources tend towards earlier life course transitions (Ravanera, 1995; Ravanera, Rajulton, and Burch, 1998, 2002; Lochhead, 2000). For example, women whose mothers have elementary education had their first child 3 years earlier than those whose mothers had college education (Ravanera et al, 1998). Cohabitation, more common among those in low socioeconomic position, and union at a young age are associated with higher probabilities of union dissolution, most often ending in lone parenthood. And, compared to cohabiting, married, or single women, young formerly married women have greater number of children (Ravanera, 1995). All these lead to what may be termed as "bifurcation" of family formation and dissolution (Bianchi, 2000).
One of the research projects will compare by socio-economic positions the trajectories towards first birth and lone parenthood (through other early life course events of school completion, home-leaving, start of regular work, and first union). This will make use of retrospective longitudinal data collected through the 2001 General Social Survey of the Family and analyzed through LIFEHIST, a software package for event history analysis (Rajulton, 2001). This will address the following research questions: At what stage in the life course does the bifurcation by socio-economic conditions occur? Is there a gender difference? At what average age does this bifurcation start?
On fertility - A consequence of the general tendency to delay family formation is fewer children, a concern made urgent by Canada's aging population. However, postponement of child-bearing and deliberate decision to limit the number of children as a response to risks in a post-modern globalized society are not the only factors leading to Canada's below replacement fertility level. Norms and values relating to families in general and children in particular impact on fertility. Also, policies that affect gender sharing of paid and unpaid work (for example, policies on maternity /paternity leaves or on childcare) have impact on levels of fertility as well (Beaujot and Belanger, 2001; CPRN, 2002). These and other related determinants will be examined anew with the latest data on fertility (levels, motivations for having children, best timing, ideal number) for both men and women gathered through the 2001 General Social Survey on the Family and the qualitative Survey on Fertility in London, Ontario. Research questions to be addressed are: What do young Canadians perceive as incentives and disincentives to having children? Do these vary by gender? What family policy levers can be handled to influence fertility?
B. Family structure, economic security, and health over the life course
About 12 percent of Canadian families live in poverty (NCW, 1999). The poverty rate varies considerably by family structure; 51.8 percent of single mothers, 18.0 percent of single fathers, and 10.4 percent for two-parent families (NCW, 1999). An increase in the labour force participation of married women has led to substantial increases in total household incomes among two-parent families while demographic changes among lone parent families have limited their family incomes (McQuillan, 1992). The result has been a consistently wide income gap between two-parent and lone parent families, single mother families especially.
The effects of poverty on health are pervasive and pernicious. Economic disadvantage contributes to psychological distress among adults (Horwitz, 1984). Economic strains including job loss, economic hardship, and financial strain contribute to elevated levels of physical and mental health problems (Avison, 1998; Menaghan and Parcel, 1990; Mirowsky and Ross, 2001). Although employment generally benefits health, these benefits vary according to family structure and gender (Ali and Avison, 1997; Davies and McAlpine, 1998; Edin and Lein, 1997). For example, given the poor employment opportunities and limited childcare arrangements, employment may undermine health (Parcel and Menaghan, 1997; Davies and McAlpine, 1998). Role demands and responsibilities associated with single motherhood limit their ability to juggle work and family (McMullin et al., 2002). Greater attention to the health implications of mothers' work and family arrangements is needed.
There is little doubt that poverty has some effect on children's emotional well-being. Results from some of the classic studies of children's mental health suggest that rates of emotional and behavioural problems are significantly higher among children from disadvantaged circumstances (Langner et al., 1974; Rutter et al., 1973; Offord et al., 1987; Duncan and Brooks-Gunn, 1997). Children's well-being is a product of investment not only of financial but of human and social capital, the transfer of which mainly occurs within family settings (Beaujot, 2000). Studies on family transformation and social cohesion show that human and social capital affect the development of children as well as their integration into society (Kerr, 2001; Kerr and Beaujot, 2001; Ravanera, Rajulton and Turcotte, forthcoming; Ravanera, Rajulton and Burch, 2002).
This set of contextual factors that condition the relationship between economic security and health takes on added complexity when we consider another important factor: stage of life. Although there is a large body of literature on health across the life course (e.g. George, 1999, 2001), we know little about how the relationships among family status, economic insecurity and health vary with age. Virtually no research has examined whether the economic hardships experienced by lone parents have more pronounced effects among younger or older individuals, or what happens to single mothers in terms of economic security and health when their children leave home. (But see Galarneau and Sturrock, 1997; Galarneau, 1998.) Hughes and Waite (2002) speculate that changes in household structure over time affect health by varying the balance between perceived demands and the availability of resources to deal with such demands. Unfortunately, much of the research on these issues has been based on cross-sectional data, limiting our potential to address the life course.
Finally, reliance on cross-sectional data for policy development can be misleading. As Ali and Avison (1997) have pointed out, "policy and program interventions based on cross-sectional analyses may be at odds with interventions based on longitudinal analyses. Given that most interventions are designed to stimulate change, it seems advisable that the empirical basis for such initiatives be derived from change data rather than from static data. At the same time, however, reliance on longitudinal data must be accompanied by an awareness that there may be important differences between individuals whose status changes over time and those whose position in the social structure is more stable" (p. 360). Moreover, income and health trajectories are dynamic and sensitive to social change and political agendas (McMullin et al., 2002). We will capture the dynamics of change in family structure, income security, and health so that we can generate useful information for policy development.
To address our objectives, the proposed research will explore the following questions: How do changes in family status affect economic security and health of women and men? Does this vary by life course stage? How do changes in family status affect economic security and health of children? Does this vary by life course stage? What are the relations between children's health and socio-economic positions (indicated by amount and sources of parental income, duration of poverty spells, and timing of the occurrence of poverty)? Do these effects vary by age of children and by family structures? Do community characteristics make a difference in the impact of socio-economic position on children's physical health? Do these effects vary by regions? Do employment status and work conditions mediate or moderate the relationship between changes in family status and health? Is it possible to reformulate existing policy in a way that would effectively improve the economic security among a diverse group of mothers and their children, or do new policies need to be written to achieve this goal? What are the concrete policy solutions?
To answer these questions, we will draw on the National Population Health Survey (NPHS). We will do multiple and logistic regression analyses to examine the impact of transitions into and out of employment on changes in health outcomes (a) among those with stable employment with those who become unemployed, and (b) among those who are continuously unemployed with those who become employed, allowing us to focus on the health consequences of employment status changes between "movers" and "stayers" for all mothers and also by family structure. Strains and psychosocial resources will then be added to identify mechanisms through which transitions affect well-being for the two groups. In a series of parallel analyses, transitions into employment will be examined separately from transitions out of employment.
The analysis of the impact of socio-economic position (including sources and levels of income) on children's health necessarily call for the inclusion of other factors that have effects on children, the most important of which are those pertaining to families. Making use of the National Longitudinal Survey of Children and Youth, this study will examine the physical and mental health of children at 4 stages: infancy and toddler, early childhood, late childhood, and early adolescence. The effects over time of level and sources of income and related factors such as family structures, mother=s education, mother's employment status, mother's age at birth of the child, and number of children in the family will be examined using techniques of analysis appropriate to longitudinal data including simple exploratory descriptive techniques to analyze changes such as turnover tables (Vermunt, 1997) and multivariate techniques such as structural equations models (Joreskog, 2000).
C. Family and community determinants of health
In the United States, studies have shown that social cohesion (or specifically, social capital) influences the individual's health-related behaviours; access to services and amenities, and psycho-social processes (Kawachi, 2000, Kawachi and Berkman, 2000, Kawachi, Wilkinson, and Kennedy, 1999). There is a concern that social capital in the United States and elsewhere is declining (Putnam, 1993, 2000) and that this is mainly due to increasing income inequality (Kawachi et al, 1999).
In contrast to the United States, Ross et al. (2000) find that there were no significant associations between mortality and income inequality in Canada. And, Tremblay, Ross, and Berthelot (2002) show that there is no strong influence of social environment on individual health status in Canada, a finding contrary to those in the US and Great Britain. They propose that this may be due to the range of social and health policies that prevent health inequalities by region. They noted, however, that social context effects (such as that of social capital) may be best detected at neighbourhood level rather than at the level of health regions.
Other studies have found health differentials by neighbourhood and regions in Canada. Health regions that differ in socio-demographic and economic characteristics also differ in life expectancies, disability-free life expectancies, and life styles such as, smoking, drinking, obesity, and depression (Shields and Tremblay, 2002; Mayer et al, 2002). And, while mortality differentials by neighbourhood income have decreased between 1971 and 1996, nevertheless, differentials persist for some causes of death and have widened for a few other causes (Wilkins, Berthelot and Ng, 2002).
Some of the health variations by region or neighbourhood could be due to the concentration of individuals of similar socio-economic status in certain areas (compositional effect) and thus, could be accounted for by individual-level characteristics. However, factors inherent to the neighbourhood or region (contextual effects) could not be ruled out. Some of these factors could be variations in socio-economic conditions (such as social cohesion or social capital, income inequality, or availability of health care facilities and services). Contextual effects could be detected mainly through the inclusion in an analysis of both community and individual-level factors B that is, through multi-level analysis.
Studies Using General Social Survey on Time Use and National Population Health Surveys. Integration, an indicator of social cohesion at the individual level, is affected by health status - those in good health are more likely to be economically included, politically participative, and feel stronger sense of belonging (Ravanera and Rajulton, 2001). This is a selection effect - those who are healthy select themselves into favourable economic and social positions. But, the relationship could be causal - less socially integrated individuals are also at increased risk of poor health outcomes (Kawachi, Wilkinson, and Kennedy, 1999).
Using the 1998 General Social Survey on Time Use merged with community variables derived from the 1996 census, this study will explore the relationship between the individual self-rated health status and the economic, political, and social dimensions of integration of Canadians at early, mid, and late life. It will examine (through multinomial logistic regression) individual self-rated health and how it is affected by individual integration, socio-economic positions (such as education, level and sources of income, work schedules and work-related stress) and by community features such as size and location, affluence, opportunity structures, and cultural homogeneity.
Data from the National Population Health Surveys will be similarly analyzed with focus on changes that have occurred between time points in health outcomes and in the variables of interest. In addition to health-related data, the NPHS also gathered information on economic inclusion and social involvement. To enable a multi-level analysis, data on community characteristics (from the census) and measures of social cohesion (derived from the National Survey of Giving, Volunteering, and Participating) will be attached to the individual longitudinal file making use of geographic indicator in the NPHS.
The proposed study would address research questions such as: Does the health impact of economic position (indicated by level and sources of income, change in employment status, or irregular work schedules) vary with political or social integration? Does it vary with region and community characteristics? For example, if the health effect of income transfer in the Atlantic differs from the rest of Canada, could it be attributed to difference in community cohesion?
Cross-sectional studies using Canadian Community Health Survey and Participation and Activity Limitation Survey. Several of the questions relating to family structure, economic security and community determinants can be further studied through the 2000-2001 Canadian Community Health Survey (Béland, 2002) and the 2001 Participation and Activity Limitation Survey (Statistics Canada, 2002a). As reported in Health Reports, these surveys have the advantage of particularly large sample sizes. The PALS also follows the 1986 and 1991 Health and Activity Limitations Surveys. Both have various measures of health and interaction with the health system, as well as measures of the determinants associated with family, socio-economic status and community.
Funded by Human Resources Development Canada, the PALS provides an alternate measure of health status, for the non-institutionalized population. There are measures of the types of disability, and their severity. The Canadian Community Health Survey also includes a measure of respondent's "sense of belonging to their local community." Ross (2002) finds that the differentials associated with reporting very good or excellent health are stronger by the five categories of sense of community belonging than by sex, age, marital status, presence of children under 12, currently has job, and residential area, but the differentials are stronger by education and by household income. These analyses need to be pursued further, including building a more complex measure of family status from the age, marital status and presence of children variables.
The CCHS includes a measure of "unmet health care needs," and contact with health care professionals. As seen in the 2002 How healthy are Canadians (Health Reports, 2002), the CCHS is useful for analysing both regional or community differences, and individual determinants of self-perceived health. This report includes analyses of regional differences in self-reported unmet health care needs (Tremblay et al., 2002), health of the off-reserve Aboriginal population (Tjepkema, 2002), the health status and health behaviour of immigrants (Pérez, 2002a) and the mental health of Canada's immigrants (Ali, 2002). The same survey was used to analyse shift work and health (Shields, 2002), and the influence of fruit and vegetable consumption (Pérez, 2002), in earlier issues of Health Reports. An analysis of Regional socioeconomic context and health (Statistics Canada 2002b) finds that individual factors such as education and income, and health-related risk factors, such as obesity, play a larger role than the regional socioeconomic context in which the respondent lives. The health measures include various chronic conditions, long-term activity restriction and major depressive episode, while the health behaviour include smoking status, body mass index, alcohol consumption and physical activity.
These data sets will allow us to pursue various cross-sectional analyses. For instance, we are interested to analyse further the influence of non-standard work patterns that the time-use survey has found to have rather disruptive effects on family time (Rapoport and Le Bourdais, 2002. Lapierre-Adamcyk, 2002). Since few surveys have measures of community belonging, the CCHS will provide a measure of social cohesion, which can be further related to family status and health. The other measures of socio-economic status, including education and income, will provide further determinants, at least for purposes of control. The size of the surveys also permit analyses on various sub-populations, such as recently arrived immigrants and First Nations Peoples, who may have different access to health services.
To sum up, the links between the family and community to health (see Figure 1) will be examined using existing cross-sectional and longitudinal data and appropriate techniques. Seven investigators will collaborate with defined responsibilities based on each investigator's research expertise and interests.
Ali, J. 2002. Mental Health of Canada's Immigrants. Supplement to Health Reports 13: 101-111.
Ali, J. and W. R. Avison. 1997. "Employment Transitions and Psychological Distress: The Contrasting Experiences of Single and Married Mothers." Journal of Health and Social Behavior 38:345-362.
Avison, W. R. 1998. "The Health Consequences of Unemployment." Pp. 3-41 in National Forum on Health (ed.), Determinants of Health: Adults and Seniors. Ottawa, ON: Editions MultiMonde.
Beaujot, R. 2000. Earning and Caring in Canadian Families. Peterborough: Broadview.
Beaujot, R. and A. Belanger. 2001. Perspectives on Below Replacement Fertility in Canada: Trends, Desires, and Accomodations. Population Studies Centre Discussion Paper 2001-6.
Beaujot, R. and Z.R. Ravanera. 2001. An Interpretation of Family Change with Implications for Social Cohesion, Population Studies Centre, Discussion Paper No. 2001-1.
Béland, Y. 2002. Canadian Community Health Survey - Methodological Overview. Health Reports 13(3): 9-14.
Berkman, L.F. and I. Kawachi. 2000. (eds) Social Epidemiology. Oxford University Press.
Bianchi, S.M. 2000. Maternal Employment and Time with Children: Dramatic Change or Surprising Continuity. Demography 37(4): 401-414.
Blane, D. 1999. The Life Course, the Social Gradient, and Health. In M. Marmot and R. G. Wilkinson (eds) Social Determinants of Health. Oxford University Press. Pp. 64-80.
Canadian Policy Research Network, Inc. (CPRN). 2002. Final Report: Child Care Policy Conference. Available at: http://www.cprn.org/docs/family/ccp_e.pdf
Côté, J.E. and A.L. Allahar. 1994. Generation on Hold: Coming of Age in the Late Twentieth Century. Toronto: Stoddart.
Davies, L., J. A. McMullin, and W. R. Avison with G. L. Cassidy. 2001. Gender Inequality, Poverty and Social Policy. Ottawa: Status of Women Canada.
Davies, L. and P. J. Carrier. 1999."The Impact of Power Relations on the Division of Household Labour." Canadian Journal of Sociology 24:35-52.
Davies, L. and D. D. McAlpine. 1998. "The Significance of Family, Work and Power Relations for Mother's Mental Health." Canadian Journal of Sociology 23:368-388.
Drever, F. and Whitehead, M. 1997. Health Inequalities. The Stationery Office. London.
Duncan, G.J. and J. Brooks-Gunn. 1997. Consequences of Growing Up Poor. New York: Russell Sage Foundation
Emmons, K.M. 2000. Health Behavior in a Social Context. In L. Berkman and I. Kawachi (eds) Social Epidemiology. Oxford University Press. Pp. 242-266.
Galarneau, D. 1998. Income after Separation: People without Children. Perspectives on Labour and Income 10(2): 32-27.
Galarneau, D. and J. Sturrock. 1997. Family Income after Separation. Perspectives on Labour and Income 9(2): 18-28.
George, L. K. 2001. "The Social Psychology of Health." In Handbook of Aging and the Social Sciences, edited by R.H. Binstock and L.K. George. San Diego, CA: Academic Press.
George, L.K. 1999. "Life Course Perspectives on Mental Health." In Handbook of the Sociology of Mental Health, edited by Carol S. Aneshensel and Jo C. Phelan. New York: Plenum Press.
Health Reports, 13(1). 2002. Statistics Canada. Catalogue No. 82-003-XPE.
Horwitz, A.V. 1984. "The Economy and Social Pathology." Annual Review of Sociology 10:95-119.
Hughes, M.E. and L. J. Waite. 2002. "Health in Household Context: Living Arrangements and Health in Late Middle Age" Journal of Health and Social Behavior 43:1-21.
Joreskog, K.G., D. Sorbom, S. Du Toit and M. Du Toit. 2000. LISREL 8: New Statistical Features. Second printing with revisions. Chicago: Scientific Software International.
Kawachi, I., Wilkinson, R.G. and B. P. Kennedy. 1999 (eds) Introduction. In The Society and Population Health Reader: Income Inequality and Health. The New Press. New York. Pp. xi-xxxiv.
Kawachi, I. 2000. Social Cohesion and Health. In Tarlov, A. R. and R.F. St. Peter (eds) The Society and Population Health Reader: A State and Community Perspective. Pp. 57-74.
Kawachi, I. and L. Berkman. 2000. Social Cohesion, Social Capital, and Health. In L. Berkman and I. Kawachi (eds) Social Epidemiology. Oxford University Press. Pp. 174-190.
Kerr, D. 2001. Family Transformations and the Well-Being of Children: Recent Evidence from Canadian Longitudinal Data.. University of Western Ontario, Population Studies Center Discussion Paper 01-17.
Kerr, D. and R. Beaujot. 2001. Family Relations, Low Income and Child Outcomes: A Comparison of Canadian Children in Intact, Step and Lone Parent Families. University of Western Ontario, Population Studies Center Discussion Paper 01-8.
Langner T.S., J.C. Gersten, E.L. Greene, J.G. Eisenberg, J.H. Herson, and E. McCarthy. 1974. "Treatment of Psychological Disorders among Urban Children." Journal of Consulting and Clinical Psychology 42:170-179.
Lapierre-Adamcyk, E. 2002. Family Transformation and Labour Market. Paper presented at the Third FTSC Workshop. Paper available at http://www.ssc.uwo.ca/sociology/ftsc/third_workshop.htm .
Lennon, M. C. and Rosenfield, S.1994. "Relative Fairness and the Division of Housework: The Importance of Options". American Journal of Sociology 100:506-31.
Lynch, J. and G. Kaplan. 2000. Socioeconomic Position. In L.F. Berkman and I. Kawachi (eds) Social Epidemiology. Oxford University Press. Pp. 13-35.
Lochhead, C. 2000. The Trend Toward Delayed First Childbirth: Health and Social Implications. Isuma (Autumn): 41-44.
Marmot, M. and R.G. Wilkinson (eds). 1999. Social Determinants of Health. Oxford University Press.
Mayer, F., N. Ross, J. Berthelot, and R. Wilkins. 2002. Disability-free Life Expectancy by Health Region. Health Reports 13(4): 49-60.
McLeod, J. D. and M. J. Shanahan. 1993. "Poverty, Parenting, and Children's Mental Health." American Sociological Review 58:351-366.
McMullin, J.A., L. Davies and G.L. Cassidy. 2002. "Welfare Reform in Ontario: Tough Times in Mothers' Lives" Canadian Public Policy 28:297-314.
McQuillan, K. F. 1992. "Falling Behind: The Income of Lone-Mother Families, 1970-1985." Canadian Review of Sociology and Anthropology 29: 511-523.
Menaghan, E. G. 1997. "The Daily Grind: Work Stressors, Family Patterns, and Intergenerational Outcomes." Pp. 115-147 in Stress and Mental Health: Contemporary Issues and Prospects for the Future, edited by W.R. Avison and I.H. Gotlib. New York: Plenum Press.
Menaghan, E.G. and T.L. Parcel. 1990. "Parental Employment and Family Life: Research in the 1980s." Journal of Marriage and the Family 52:1079-98.
Mirowsky, J. and C. E. Ross. 1998. Education, Personal Control, Lifestyle and Health. Research on Aging 20(4) :415-449.
Mirowsky, J. and C. E. Ross. 2001. "Neighborhood Disadvantage, Disorder, and Health." Journal of Health and Social Behavior 42:258-267.
National Council on Welfare. 1999. Poverty Profile 1999. Ottawa: www.ncwcnbs.net/htmdocument/reportpovertypro99/Introduction.html
Offord, D. R., M. H. Boyle, and B.R. Jones. 1987. "Psychiatric Disorder and Poor School Performance Among Welfare Children in Ontario." Canadian Journal of Psychiatry 32:518-525.
Parcel, T. L. and E. G. Menaghan. 1997. "Effects of Low-Wage Employment on Family Well-Being" The Future of Children (Special Issue on Welfare to Work) 7: 116-121
Pérez, C.E. 2002. Health Status and Health Behaviour among Immigrants. Supplement to Health Reports 13: 89-100.
Pérez, C.E. 2002a. Fruit and Vegetable Consumption. Health Reports 13(3): 23-32.
Putnam, R. 1993. Making Democracy Work: Civic Traditions in Modern Italy. Princeton University Press.
Putnam, R.D. 2000. Bowling Alone : The Collapse and Revival of American Community. New York : Simon & Schuster.
Putnam, 1993, 1995
Rajulton, F. 2001. Analysis of Life Histories: A State Space Approach. Canadian Studies in Population 28(2): 341-359.
Rapoport, B. and C. Le Bourdais, 2002. Parental Time and Working Schedules. Family Transformation and Social Cohesion paper. Available at http://www.ssc.uwo.ca/sociology/ftsc/
Ravanera, Z. 1995. "A Portrait of the Family Life of Young Adults." In R. Beaujot, E.M. Gee, F. Rajulton, and Z.R. Ravanera, eds., Family over the Life Course. Ottawa: Statistics Canada, cat. no. 91-543.
Ravanera, Z. F. Rajulton, and T. K. Burch. 1998. "Early Life Transitions of Canadian Women: A Cohort Analysis of Timing, Sequences, and Variations." European Journal of Population 14: 179-204.
Ravanera, Z. and F. Rajulton. 2001. Integration at Late Life: Inclusion, Participation, and Belonging among the Elderly. Population Studies Centre Discussion Paper 01- 16. Paper presented at the 2001 Meeting of the Federation of Canadian Demographers. Ottawa.
Ravanera, Z. R., F. Rajulton, and T.K. Burch. 2002. "Effects of Community and Family Characteristics on Early Life Transitions of Canadian Youth". University of Western Ontario, Population Studies Center Discussion Paper 02-05. Paper Presented at the 2002 Annual Meeting of the Population Association of America. Atlanta.
Ravanera, Z.R. F. Rajulton, T.K. Burch and C. Le Bourdais. 2002. The Early Life Courses of Canadian Men: Analysis of Timing and Sequences of Events; Canadian Studies in Population. 29: 293-312.
Ravanera, Z., F. Rajulton, and P. Turcotte. (Forthcoming). Youth Integration and Social Capital: An Analysis of the Canadian General Social Surveys on Time Use.
Youth and Society.
Reskin, B. and I. Padavic. 1994. Women and Men at Work. Thousand Oaks: Pine Forge Press.
Ross, N. 2002. Community Belonging and Health. Health Reports 13(3): 33-39.
Ross, C. and J. Mirowsky. 1999. Refining the Association Between Education and Health: The Effects of Quantity, Credential, and Selectivity. Demography 36(4): 445-460.
Ross, N.A., M.C. Wolfson, J.R. Dunn, J. Berthelot, G.A. Kaplan, and J.W. Lynch. 2000. Relation between Income Inequality and Mortality in Canada and in the United States: Cross Sectional Assessment Using Census Data and Vital Statistics. British Medical Journal. 320: 898-902.
Rutter, M. 1973. AWhy Are London Children So Disturbed?@ Proceedings of the Royal Society of Medicine 66:1221-1225.
Shields, M. 2002. Shift Work and Health. Health Reports 13(4): 11-34.
Shields, M. and S. Tremblay. 2002. The Health of Canada's Communities. Supplement to Health Reports 13: 1-24.
Statistics Canada. 2002a. Participation and Activity Limitation Survey: A Profile of Disability in Canada. The Daily, December 3.
Statistics Canada. 2002b. Regional Socio-economic Context and Health. The Daily, August 1.
Tjepkema, N. 2002. The Health of the Off-Reserve Aboriginal Population. Supplement to Health Reports 13: 73-88.
Tremblay, S., N. Ross, and J. Berthelot. 2002. Regional Socio-economic Context and Health. Supplement to Health Reports 13: 33-44.
Vermunt, J.K. 1997. LEM: A General Program for the Analysis of Categorical Data. Tilburg University.
Wilkins, R., J. Berthelot, and E. Ng. 2002. Trends in Mortality by Neighbourhood Income in Urban Canada from 1971 to 1996. Supplement to Health Reports 13: 45-72.