Family Status and Health Behaviors: Social Control as a Dimension of Social Integration

Author(s): Debra Umberson

Source: Journal of Health and Social Behavior, Vol. 28, No. 3 (Sep., 1987), pp. 306-319
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/2136848
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FamilyStatusand HealthBehaviors:Social Controlas a
DimensionofSocialIntegration*
DEBRA UMBERSON
University
ofMichigan

of Healthand Social Behavior1987, Vol. 28 (September):306-319

Journal

Age-adjustedmortality ratesare higherfor theunmarried and nonparents thanfor themarriedand

parents.The effects of maritaland parentalstatuson mortality are usuallyattributedto thepositive
effects or social support.Themechanisms
ofsocial integration bywhichsocial supportor integrationis
linkedto healthoutcomes,however,remainlargelyunexplored.One mechanism mayinvolvehealth
behaviors;thefamilyrelationships of marriageand parentingmayprovideexternalregulationand
of healthbehaviorswhichcan affecthealth.The presentstudyemploysa
facilitateself-regulation
nationalsample to examinetherelationships of maritaland parentingstatusto a varietyof health
behaviors.Resultsindicatethatmarriageand presenceofchildrenin thehomehavea deterrent effect
on negativehealthbehaviors.It is suggested,withinthetheoretical framework of social integration,
thatfamilyrolespromotesocial controlofhealthbehaviorswhichaffectsubsequentmortality.

The literatureon social supportand social healthbehaviorsthatinfluencemortality.Pro-

integrationyields convincing evidence that spective studies (e.g. Berkman and Breslow
involvementin social relationshipsenhances 1983) demonstratethat a variety of health
individualwell-being,bothphysicaland psycho- behaviorscontributes to mortality.In thisstudy
logical. The present study focuses on the a conceptual model of social control as a
physical health benefitsof social integration dimensionof social integration to illustratehow
providedby marriageand parenting.Studiesof maritaland parentalrolesaffecthealthbehaviors
social relationshipsand mortality conclude that is developed. Data froma nationalsurveyare
familyrelationships are particularlyinstrumental used to evaluate the impact of marital and
in protectingindividual health; age-adjusted parentalties on healthbehaviorsand to assess
mortalityrates are consistentlyhigherfor the evidence for the conceptual model of social
unmarriedthan for the married(Berkmanand control.
Syme 1979; Blazer 1982; Gove 1973; House,
Robbins, and Metzner 1982). One studyalso
demonstratesthat age-adjustedmortalityrates SOCIAL RELATIONSHIPS
are higher for nonparentsthan for parents AND MORTALITY
(Kobrinand Hendershot1977).
Numerous possible pathways exist, both Several scholarshave conductedprospective
physiologicaland social-psychological, by which studies of the relationshipbetween social ties
social relationships may affecthealthoutcomes. and mortality(e.g. Berkmanand Syme 1979;
One pathway is through health behaviors; Blazer 1982; House et al. 1982). These studies
involvementin social relationshipsmay affect demonstrateconsistentlythat individualswho
lack social ties at the,time of initialmeasure-
* Direct all correspondenceto: Debra Umberson, ment are morelikelyto die duringthefollow-up
SurveyResearchCenter, Institute
forSocial Research, period. Among the relationshipsexamined,the
Universityof Michigan,AnnArbor,MI 48106-1248. maritalrelationshipis one of the most consis-
An earlierversionof thispaperwas presentedat the tentlyimportant categoriesof social contactin
annualmeetingof The AmericanSociologicalAssocia- predicting mortality. In addition, mortality
tion, New York, 1986. I would like to thankWalter
Gove,JamesHouse,MichaelHughesandJackGibbsfor
differences betweenthemarriedand theunmar-
commentson previous drafts. This research was ried are greaterformen thanforwomen.
supportedin partby NIMH grant# 5T32MH16806-05. The notionthatparenthoodprotectsindividu-

306

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FAMILY STATUS AND HEALTH BEHAVIORS
als frommortalityhas not been consideredas
extensively as the effect of marital status.
Durkheim(1951) stressedtheimportanceof the
parent-childrelationshipas a source of social
integrationin his classic study of suicide, in
whichsuicide rateswere foundto be higherfor
the childless than for parents. Kobrin and
Hendershot (1977) recently analyzed U.S.
census and healthstatisticsdata and foundthat
among marriedpersons,"death ratesare much
higherforthose withoutchildrenthanforthose
with children" (1977, p. 741); the impact is
greater for women than for men, and for
younger parents than for older. Veevers,
extrapolating fromnationaldata, speculatesthat
"a large part of the variationin suicide rates
which has been attributedto different marital
statusesmay more accuratelybe attributedto
differentparentalstatuses"(1973, p. 135).
The mechanismsby which social relation-
ships influencephysical health and mortality
remain one of the most importantand least
understoodaspectsof researchon social tiesand
individual well-being. In the recent research
the mechanismslinkingsocial ties to
literature,
mortalitycan be grouped into four general
categories: (1) individual attributesincluding
personalitycharacteristics,coping strategies,
and psychological impairment-all of which
may influencereactionsto stress,how one deals
withhealthconcerns,the appraisal of stressful
events, and the availabilityof social ties (e.g.
Lieberman 1982; Wortman1984); (2) behav-
ioral mechanismsby whichsocial ties facilitate
compliance with medical regimensor motiva-
tion to engage in healthfulbehaviors (e.g.
Berkman1984; Caplan, Harrison,Wellons, and
French 1980); (3) physiologicalor biochemical
mechanisms,such as neuroendocrine responses
to the presence of others (e.g. Berkman and
Syme 1979; Broadhead,Kaplan,James,Wagner,
Schoenbach, Grimson, Heydon, Tibblin, and
Gehlbach1983); and (4) buffering or prevention
of situationalfactorssuch as chronicstrain,life
events,or environmental stressors(e.g. Lieber-
man 1982; Thoits 1982; Wortman1984). Each
of thesecategoriesmustbe examinedsinglyand
in combinationin order to build an accurate
model of the effectsof social relationshipson
health.Probablyeach of the above mechanisms
operates to some extent, and the primary
mechanismvaries accordingto populationand
outcomevariable.The presentstudyexploresa
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307
particularbehavioral mechanismwhich is ex-
pressedin the formof healthbehavior.
The relationshipof healthbehaviorsto health
and mortalityis well documented(Belloc 1973;
Belloc and Breslow 1972; Berkmanand Breslow
1983; Breslow and Enstrom 1980; Hamburg
1982; Kaplan and Comacho 1983). Health
behaviorsshownto affectphysicalhealthand/or
mortalityinclude physical activity (Berkman
and Breslow 1983; Kannel 1967), cigarette
smoking (Berkman and Breslow 1983; U.S.
Departmentof Health, Education,and Welfare
1975a), maintainingappropriatebody weight
(Kannel 1971; U.S. Departmentof Health,
Education, and Welfare 1975b), alcohol con-
sumption(Berkman and Breslow 1983; U.S.
Departmentof Health, Education,and Welfare
1975c; Wiley and Comacho 1980), sleep
patterns(Belloc 1973; Berkman and Breslow
1983), and compliance with prescribedhealth
regimens (Hamburg 1982). In a prospective
studyof healthbehaviorsand mortality, Berk-
man and Breslow conclude:
Withoutexception, for every age and sex
groupexamined,people withhigh-risk health
practiceshad highermortality ratesthanthose
with a medium numberof low-riskhealth
practices.Those who maintainedthe greatest
numberof low-riskhealthpracticeshad the
lowestmortality rates. (1983, p. 106)
Berkmanand Breslow (1983) foundthatsocial
networksand healthfulbehaviorshad an addi-
tiveeffecton changein physicalhealth,as well
as on mortality.
In sum,previousresearchindicatesthatsocial
ties (e.g. House et al. 1982) and health
behaviors (e.g. Berkman and Breslow 1983)
affect mortality.There is also evidence to
suggest that social ties affect some health
behaviors, such as compliance with medical
regimens(Caplan et al. 1980; Cobb 1976; Levy
1983). These findingssuggestthatpart of the
impact of social ties on subsequentmortality
mayoccurindirectly throughits effecton health
behaviors.Several authorsof social relationship
and mortalitystudies suggest that mortality
differencesamong maritalstatus(Berkmanand
Syme 1979; Gove 1973; House et al. 1982;
Hughes and Gove 1981; Syme 1974) and
parentingstatus(Kobrin and Hendershot1977)
groups exist partlybecause the unmarriedand
nonparents are morelikelythanthemarriedand
308 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
parentsto engage in behaviorsthatcontribute to
mortality.
How might social relationshipsaffect the
inclination to engage in health behaviors?
Although all social ties have some basic
elementsin common,the mechanismsunderly-
ing the impacton healthof formalrelationships
(e.g. church membership)may differ from
informal, more intimate relationships (e.g.
family)(Litwak 1985). This studyfocuses on
the informalkin relations of marriage and
parenting.These relationships were selectedfor
study because (1) intimate ties, especially
marriage,have been shown to have a greater
impact on mortalitythan other, less intimate
ties; and (2) marriage and parenting are
examples of primarygroup ties, a traditional
focus in studies of the effects of social
integration on the individual.
A substantialpartof Durkheim's(1951) work
on social integrationfocused on the relation-
ships of marriageand parenting.He saw these
relationshipsas providingthe individualwitha
sense of meaningand purposeas well as a setof
importantobligations. In turn, the sense of
meaningand theobligationsaffectedtheindivid-
ual's motivationsand lifestyle.The effectsof
social integrationvia the family, Durkheim
argued,were seen in thebehavioraloutcomeof
suicide: suiciderateswerelowerforparentsand
forthemarried.
Durkheim(1951), Syme (1974), and Gove
(1973) have arguedthatthemarriedhave lower
mortality ratesthanothermaritalstatusgroups
partly because marriage provides a healthy
social environmentfor its participants.This
environment may be due to an enhanced"sense
of meaning and importance,"which inhibits
self-destructiveacts (Gove 1973), or may exist
because marriedindividualsare morelikelythan
others to have someone who regulates their
behaviorin an adaptiveway (Hughes and Gove
1981). There is evidencethatmarriedindividu-
als and parentsexperiencesignificantly lower
levels of meaninglessnessthando theirunmar-
ried and childless counterparts, supportingthe
formerexplanation(Umbersonand Gove 1986).
Gove's 1973 studyof sex, maritalstatus,and
mortality lends plausibilityto the latterhypoth-
esis that marriage serves to regulate health
behaviors.
In his 1973 study,Gove used data fromthe
NationalCenterforHealthStatisticsto examine
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several different categoriesof cause of death,
which varied in the degree to which the
individual played a role in the etiology or
treatment.He concluded that the married
exhibited lower rates of mortalitythan the
unmarriedfor virtuallyall causes of death in
whichthe individual'spsychologicalstateand/
or behavior played a substantialrole. The
mortality differencebetweenmarriedand unmar-
ried persons, for example, was greatestfor
causes of death in which the individualplayed
themostdirectrole (e.g. suicide). The mortality
differencebetweenthe marriedand unmarried
was less, but quite strong,for causes such as
cirrhosisof the liver, in which a behavior
(alcohol consumption)affectsthe etiologyand
courseof thedisease. In contrast,forleukemia,
a disease on which the individualhas minimal
influence, there was virtuallyno difference
betweenthe mortality ratesof the marriedand
theunmarried.
Gove arguedthatthestateof beingmarriedis
relatedto (1) psychologicalwell-being,thelack
of whichcontributes to certaincauses of death
(e.g. accidents,homicide,suicide); (2) activities
leading to death (e.g. smoking,drinking);and
(3) the willingness and ability to undergo
treatment for certaindiseases (e.g. tuberculo-
sis). For all these causes of mortality,the
marriedhad substantially lowerratesof mortal-
ity than the unmarried;the relationshipis
particularlystrong where the link between
psychologicalstateand death is most obvious.
In conclusion, Gove hypothesizedthat the
revealed patternsof mortalitywere due to
genderand maritalroles:marriagecontributes to
psychologicalwell-being,especially for men,
and the presence of a spouse discourages
activities leading to death and encourages
compliance to treatmentregimens (also see
Gove 1972).
Although Gove (1973) hypothesized that
mortalitydifferenceswere largely due to the
effectsof genderand maritalroles on psycho-
logical well-beingand healthbehaviors,he did
not assess the relationshipsamong gender,
maritalroles, and mortality-related behaviors,
nor did he elaborateon the process by which
maritalroles affectan individual's behavior.
The presentstudy addresses these issues and
determineswhethersome important health-and
mortality-related behaviorsare actuallyassoci-
ated withfamilyand genderroles. A theoretical
FAMILY STATUS AND HEALTH BEHAVIORS
explanationin also developedfortheprocessby
which social integrationthroughfamily ties
reducesmortality.
This explanationreflectsDurkheim'sclassic
view of social integration,in which the
existenceof familyrelationships(marriageand
parenting)is seen as affectingthe individual's
social environment. These relationshipsinvolve
elementsof obligationand constraint as well as
a sense of meaningand purpose. Thus family
relationshipsaffect psychological well-being
and health behaviors by shaping one's social
environment and lifestyle.A basic premiseof
thisexplanationis thatsocial integration
through
marriageand parentingcontrolsan individual's
inclinationto engage in behaviorswhich affect
health and mortality-thatboth the sense of
meaning and the obligations arising from
marriageand parentingwill inhibit negative
health behaviors and promotepositive health
behaviors.(Figure 1 illustratesthis proposition
of social control as a dimension of social
integration.)
SOCIAL CONTROL OF HEALTH
BEHAVIORS
The model in Figure 1 posits thatfamilyties
involve elements of meaning and obligation
which contributeto social control;that social
control is a mechanism by which social
relationshipsaffecthealth behaviors; and that
healthbehaviorsaffecthealthoutcomes. Social
control has been viewed traditionallyas an
influence over the individual to engage in
conventional or nondeviant behavior (Gibbs
1981; Hirschi1969; Meier 1982; Parsons 1951).
Social controlof healthbehaviorcan be viewed
in the same way as social control of other
behaviors.If we assume thathealth(theabsence
of illness) is a normativestate, then behavior
that contributesto morbidityand mortality
Figure1. Conceptual
ModelofSocialControl
amily
relationships . Social
(meaning, control
obligation
constraints
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309
(behavior that is contraryto health) can be
viewed as unconventional or deviant.
The literatureon social controlyields two
primary ways in which social control of
behavior occurs: (1) via internal influence,
primarilythroughthe internalization of norms
for conventionalbehavior (Hirschi 1969; Nye
1958; Parsons 1951); and (2) via external
influence,usually in the formof sanctionsfor
behaviordefinedas unconventionalor deviant
(Nye 1958; Parsons1951). Thus familyrelation-
ships may provide social control of health
behaviorsindirectlyby affectingtheinternaliza-
tion of norms for healthful behavior, and
directlyby providing informalsanctions for
deviatingfrombehaviorconduciveto health.
IndirectInfluenceof Social Control
Indirect social control occurs throughthe
self-enforcement of norms. Individuals may
internalizenorms of responsibilitytoward a
child or a spouse, and as a resultmay control
their own health behaviors. This sense of
responsibilitymayreflectthespecial meaningof
therelationship forthe individualor conformity
to society's normsof behaviorforthe relation-
ship. Many social controltheoristsfocuson the
role of affectionalties (e.g. family ties) as
contributing to the internalization
of normsfor
conventionalbehavior(e.g. Hirschi 1969; Nye
1958). Individualscommittedto relationships,
such as those offeredby the family,adhere to
normsforconventionalbehaviorpartlybecause
deviating from those norms threatens the
existence of the relationships(Hirschi 1969;
Nye 1958).
The simple existence of family ties may
indirectlyfacilitatehealth behaviors or deter
risk-taking in additionalways. Social relation-
ships may facilitatehealthfulbehaviorsbecause
an individualis more likelyto engage in those
Health Physical
- behaviors health/
mortality
310 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
behaviorsif he or she has someonewithwhom
to engage in such behavior-for example,
exercise. Similarly,the programmingencour-
aged by coordinationof schedules facilitates
regular eating, sleeping, or exercise. Family
mayalso facilitatehealthful
relationships behav-
ior by providinga model to be emulatedor by
leadingan individualto setan exampleforhis or
herchildren.
Direct Influenceof Social Control
The existence of marital and parenting
relationshipsmay serve to regulateor sanction
the individual for behavior which could be
detrimentalto health. This possibilityreflects
the view of social control as an external
influence over the individual (Nye 1958).
Spouses or children may tell or remind an
individualto engage in healthbehaviorsor to
avoid takingrisks. For example, an individual
mightremindhis or her spouse to avoid using
salt because of its effecton blood pressure.
Regulationmay also take the formof sanctions
or threatenedsanctions; an individual might
threatento leave a spouse because of excessive
alcohol consumption.
Family membersmay regulatehealthbehav-
iors throughdirectphysical intervention in an
effortto affectthehealthof a spouse or a parent.
For example,a familymembermay controlthe
type and amount of food available to an
individual,particularlyif the individualhas a
weightproblemor a nutritionally based health
problem. Family membersmay also intervene
physicallyby administeringprescribedhealth
treatments (e.g. insulin injections)to an indi-
vidual.
In sum, the influenceof social controloccurs
indirectlythrough the facilitationof health
behaviorsand the internalization of normsfor
conventionalbehavior,and directlyvia regula-
tion, sanctions,and physical intervention. So-
cial relationshipsmay provide social control
over health behaviors which contributeulti-
matelyto mortality.'The implicationis thatin
the absence of the control provided through
theserelationships,thereis a higherprobability
of engagingin health-compromising behavior.
The present study explores the connection
betweenfamilyrelationships (maritaland paren-
tal relationships)and health behaviors, two
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major componentsof the conceptualmodel in
Figure 1. This studywas designedto establish
whethermaritaland parentalrolesare associated
with mortality-related behaviors and to see
whetherthepatternof findingsconformsto that
predictedby the social controlargument.
DATA, HYPOTHESES, AND ANALYSIS
The subsequentanalyses are based on data
froma national sample of 2,246 respondents
collected in the contiguous United States in
1974-75. As the originalpurposeforcollecting
these data was to examine the relationships
among genderroles, maritalroles, and mental
health, the widowed and divorced (especially
males) were oversampled. The never-married
are excluded fromthe analyses of this study
because parentinginformation was notcollected
fromthemin the originalsurvey(sample size
for analysis= 1,826; for additional sampling
information, see Geerkenand Gove 1983). Six
health behaviors are consideredas dependent
variables. These variablescan be groupedinto
two generalcategories:lifestyleand substance
use/abuse.The two lifestylemeasures include
an orderly lifestyle scale and a risk-taking
behavior scale. The four substance use/abuse
measures include a measure of drinkingand
drivingfrequency,a drinkingproblem scale,
marijuana use, and substance use/abuse as a
coping technique. This cross-sectionalsurvey
does not permitan analysis of the effectof
healthbehaviorson subsequentmortality,but
available evidencesuggeststhatthesebehaviors
are relatedto physicalhealthoutcomes.
LifestyleMeasures
The risk-taking scale includesitemsreflecting
thepropensity to become involvedin arguments
and fights,take needless risks, behave care-
lessly, and have accidents.A substantiallitera-
tureon victim-precipitated homicideand assault
(Luckenbill1977; Wolfgang1966) suggeststhe
possible effectsof the propensityto fightor
argue. The tendencyto take needless risksand
to have accidentshas serious implicationsfor
health. In 1970, accidents (excluding motor
vehicleaccidents)werethefifthleadingcause of
death; motorvehicle accidents were the sixth
FAMILY STATUS AND HEALTH BEHAVIORS 311

leading cause (Omran 1980). Among individu- theconstructed

scales are includedin Appendix
als under the age of 35, accidents were the A.)
leadingcause of deathin 1970.
The orderlylifestylescale includesitemsthat
reflectthemoreroutinepatternsof livingwhich IndependentVariables
can affecthealth. This scale assesses sleeping
and eatingpatternsas well as an orderlylifestyle The major independent variables include
in general. Previous evidence indicates that marital status and parentingstatus. Marital
lifestyleas manifestedby sleeping and eating statusis a trichotomousvariable consistingof
patternsaffectsphysicalhealthand subsequent married, divorced, and widowed categories,
mortality(Wiley and Comacho 1980; Belloc dummy coded for regression purposes with
1973). married as the excluded category. Parenting
status is defined according to living arrange-
ments of parentsand children,based on the
SubstanceUse/Abuse assumptionthat living with childrenprovides
more social integrationor social controlthan
Four aspects of substance use/abuse were does living separately from one's children.
consideredas health behaviors;threeof these Parentingstatus is trichotomizedinto parents
measurespertainto theuse of alcohol. Overcon- living with children,parentsliving apart from
sumptionof alcohol contributesto violence, children, and the childless. The childless
accidents,morbidity,and mortality(Ray 1978; representthe excluded categoryin regression
Berkman and Breslow 1983). The drinking analyses. Controlvariablesincludeage (catego-
problemscale includesitems(e.g. drinkinghas ries 1-16), education(1-7), householdincome
affectedhealth,oftendrankmorethanintended) (1-21), and the dichotomousvariables of sex
which indicate patternsof alcohol abuse that ( = male, 0= female) and race (1 = nonwhite,
revealthemselvesonly afteran alcohol problem 0 = white). (Correlations,means, and standard
is fairly well established. The drinkingand deviations for all variables are provided in
drivingmeasure indicatesfrequencyof driving AppendixB.)
afterhavingseveraldrinks.Drivingwhileunder
theinfluenceof alcohol "is a causativefactorin
Hypotheses
accidents . . . Forty-five percent of all fatally
injureddrivershave a BAL (blood alcohol level)
over0.1 percent"(Ray 1978, p. 57). One of the Maritalstatusand parentingstatusare consid-
healthbehaviorsconsideredis theuse of alcohol ered as sources of social integrationwith the
or otherdrugsas a copingtechniquewhenone is potentialto providesocial controlto respondents
upset. The repeateduse of such techniquesto and consequentlyto affecthealth behaviors.
cope withstressmaycontribute to health-related Accordingto this premise,the marriedshould
problems(Schaefer1983). exhibit fewer health-compromising behaviors
The effectof marijuanause on healthis not than the unmarriedand parentsshould exhibit
entirelyclear. Recent evidence, however,sug- fewer health-compromisingbehaviors than
gests that regular use of marijuana causes nonparents. Further,parentslivingwithchildren
changes in the cardiovascularsystemsimilarto should be deterredfromsuch behaviorsmore
those caused by stress (Instituteof Medicine than parentsliving separatelyfromtheirchil-
1982). Peterson(1980) reviewsseveral clinical dren. Integrationthroughmarriageand parent-
studies which reveal that marijuana produces hood should have additive effectson health
respiratorysymptomssimilarto thosecaused by behaviorssuch thatmarriedparentslivingwith
heavy cigarettesmoking. There is also some children should exhibit the lowest levels of
evidence that marijuana smokers are over- health-compromising behaviors and childless,
represented in fatalhighwayaccidents(Peterson unmarriedgroups should exhibit the highest
1980, p. 26). Constructionof the risk-taking, levels of health-compromising behaviors.
drinkingproblems,and orderlylifestylescales The impactof social ties, especially marital
was based on factor-analytic
techniques.(Ques- status,on mortality is greaterformen thanfor
tionnaireitems and reliabilitycoefficientsfor women(House et al. 1982; Berkmanand Syme

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312 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

1979). Some researchers suggest that this used for this study, the health behaviors of
differenceis due in part to gender roles. individualsbeforemarriageand parentingcan-
Gender-rolesocialization encouragesmales to not be determined.The selection explanation
adopt behaviors which can be dangerous to cannotbe disproved,butevidencefromprospec-
health (Harrison 1978), and leads females to tive studiesdiminishesits plausibility.
avoid dangerousactivities(Waldron 1982) and It can also be argued that the personal
to be more responsive to health concerns dispositionof individualswho have childrenor
(Nathanson1977). Further,the maritalrole of marryis initiallydifferent fromthose who do
women is more likely to be characterizedby not in a way thatcould affectthe propensityto
care-giving,whichshouldbe beneficialto their engage in negativehealthbehaviors.Childhood
spouses' health (Belle 1982; Gove 1984). backgroundfactorssuch as parentaldivorce,a
Regardless of marital status, women may parent'sdrinkingproblem,or mentalillness of
benefitpersonallyfromsex-rolesocializationto parent(s)duringan individual'schildhoodmay
provide care because theirknowledge affects contributeto adult psychologic dysfunction
theirown healthbehaviorsand health(Nathan- which could be manifestedin negativehealth
son 1977). Men, however,maybenefitmoreby behaviors,and which mightaffectone's deci-
makingthetransition fromunmarried to married sion or abilityto marryor to have children.
statusbecause theyobtaina care provider.This Gove, Hughes, and Style (1983), using the
argumentsuggests that men's health benefits presentdata, foundthatthese childhoodback-
frommarriagemorethanwomen's and thatthis ground factors, although related to marital
differenceshould be expressed in levels of status,had at mostonlya verymodesteffecton
health behaviors. To test this hypothesis, the relationshipbetween marital status and
betweenmaritalstatusand genderin
interactions psychologicalwell-being.Umbersonand Gove
predictinghealthbehaviorsis assessed. (1986) also found that on the basis of these
childhood background factors, parents and
nonparentsdo not differsignificantly fromone
Selection:an Alternative Explanation another.Althoughnot provingthe absence of
selectioneffects,maritaland parentalstatuses
Most studieson the effectsof social integra- seem unable to be differentiated on thebasis of
tion and individual well-being assume that aspects of social selection that are related
something about social ties contributesto systematically to childhoodexperiences.
well-being;thatalthoughsome reciprocity may
exist between well-beingand the existenceof
social ties, muchof therelationshipresultsfrom FINDINGS
the effectof social integrationon individual
well-being.The primaryalternativeexplanation In the initialanalysis,healthbehaviorswere
is that some a priori characteristicof the regressedon parentingstatus, marital status,
individualaffectsthe propensityto have social sex, race, age, education, and income. The
ties, and this same pre-existingfactor also coefficients yieldedfromthisanalysisgenerally
affectshealthoutcomes. supportthe social controlhypothesis(see Table
According to this view, the relationship 1). Parenthoodand marriageare associatedwith
betweensocial ties and individualwell-beingis diminishedparticipationin health-compromi-
spuriousbecause of the causally a priori third sing behaviors.
variable. This variable, causally priorto mar-
riage,parenting,and healthoutcomes,could be
pre-existinghealth status. Several prospective ParentingStatus
studies,however,demonstrate thatthe relation-
ship between maritalstatus (as well as other On thebasis of magnitudeand significanceof
social ties) and mortalityremains statistically effects, parentingreduces the inclinationto
significant whena controlforpriorhealthstatus engage in negativehealthbehaviorsmorewhen
is included in analysis (House et al. 1982; childrenand parentslive in the same residence
Berkmanand Syme 1979; Blazer 1982). than when they live separately.This finding
Because of the cross-sectionalnatureof data conformsto thesocial controlhypothesisin that

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FAMILY STATUS AND HEALTH BEHAVIORS 313

TABLE 1. Regression Coefficientsfor the Effectsof Family Structureon Risk-TakingBehaviors

Drinking Risk- Orderly
Marijuana problem Drinking/ Substance taking lifestyle
use scale driving abuse/coping scale scale
Parentingstatus:
Childhome .lOa -.08c -.18 a -.02 -.02 -.02
Childaway -.01 .06 -.01 -.01 -.01 .12
(Childless= 0)
Maritalstatus:
Divorced .02 .38a .24a .12a .25a -.32a
Widowed .02 .07 .08 .02 .08 _ . 17c
(Married = 0)
Controls:
Men .05a .30a .43a .07a .13a .03
Nonwhites .00 .1iC .08 -.02 -.14b -.08
Income - .003c .00 .01 .00 .01 .01
Age -.02a -.04a - a .00 -.07- a .07a
Education .01C -. 04b .00 .00 -.03b .04c
CONSTANT: .24 .64 .47 .13 1.13 1.19
R2 .14 .11 .13 .02 .14 .10
a p?.ool.
b
p?.01.
C p?.O5.

one would expecttheresponsibility and regula-
tion providedby parentingto be greatestwhen
childrenand parentslive together.
The deterrenteffectof parentingon negative
healthbehaviorsis mostapparentforthehealth
behaviors involvinglicit and illicit substance
abuse. The strongesteffects are noted for
marijuanause, drinkingproblems,and drinking
and driving. When we consider that parents
living with childrenare typicallyyoungerand
that substance abuse and age are related
inversely,thesefindingsare quite striking.
Marital Status
The coefficientsfor maritalstatusare more
consistentthan for parentingstatus. On every
dependentvariable except marijuana use, the
divorcedand widowed are morelikelythanthe
marriedto engage in negativehealthbehaviors
and less likelyto experiencean orderlylifestyle.
The patternof effectsis similarforthedivorced
and the widowed, but the effects are not
statistically
significantforthe widowed, except
on the orderlylifestylescale. The widowed are
an older populationforwhom healthbehaviors
thatreflectsocial controlare tapped betterby InteractionEffects
routine health-protective behaviors, such as
thoseincludedin theorderlylifestylescale, than
by deviantbehaviorssuch as substanceabuse, statuson healthbehaviorsdiffersfor men and
which decline with age. The social control
hypothesissuggestsstronglythatthe shiftfrom
marriedto widowed status is detrimentalto
healthpartlybecause thereis no longera partner
to help organize routineliving habits thatcan
affecthealthoutcomes.
Several sources of evidence support the
hypothesisthat social control partlyexplains
healthoutcomes among the widowed. Helsing
and Szklo (1981) reportthat the increase in
mortalityfollowingwidowhoodis muchgreater
formenthanforwomen.Thereis also evidence
thatwomenare morelikelythanmen to assume
responsibilityfor organizingthe living habits
(e.g. preparingfood,monitoring healthsupplies
and prescriptions)whichcan have a cumulative
impacton health(Depner and Ingersoll-Dayton
1985; Depner and Verbrugge 1980; Troll,
Miller, and Atchley 1979). Taken together,
thesefindingssuggestthatmenlose moresocial
controlof healthbehaviorsthroughwidowhood
thando women,and partlyexplainthemortality
differencebetweenwidowed men and widowed
women. This same line of reasoningwould also
applyto sex differencesin mortalityratesof the
divorced.
It has been suggestedthattheeffectof marital

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314 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

for women; thatmarriagehas more beneficial and an inverserelationship to drinking

problems
effects on men's health behaviors than on and to the risk-taking scale. Age conformsto
women's. Only two significant interaction previous research (e.g. Style 1985), showing
effectsbetween sex and marital status were inverserelationshipsto negativehealthbehav-
revealed (not shown); both, however, support iors and a positive relationshipto an orderly
the above assertion.The effectof widowhood lifestyle.
on an orderly lifestyledepends on gender;
widowhoodhas a moredetrimental effecton an
orderlylifestyleformen thanforwomen (p ' Marriage and ParentingCombinations
.05). Divorce is also more detrimental to men
than to women in contributingto drinking Maritalstatusand parentingstatushave been
problems(p ' .001). Furthertestsforinterac- discussed as two separate aspects of family
tionsbetweensex and maritalstatusindicatethat structurewhich provide social integrationand
theeffectsof maritalstatuson healthbehaviors consequently social control to individuals,
are similar for men and for women. The whichaffectshealthbehaviorsin turn.Parenting
baseline levels of health-compromising behav- statusand maritalstatusin combinationdefine
iors are higher for men than for women, an individual's family structure. Although
however. interactionsamong marital status, parenting
The impactof parentingon healthbehaviors status,and genderwere not frequently signifi-
can also varyby gender.Kobrinand Hendershot cant, theremay be important trendsalong these
(1977) foundthatparenting was associatedmore dimensionswhichhelp to illuminatetheprocess
stronglywith women's mortalitythan with by which social integrationaffects health
men's. An assessment for interactioneffects behaviorsformen and forwomen. In Tables 2
between sex and parentingstatus, however, and 3, the primaryindependentvariable com-
yielded no significantresultswith the present prisesninecategories,whichrepresent thethree
data, indicatingthatparentingaffectsmen's and marital-statusand the three parenting-status
women's healthbehaviorsin a similarfashion. combinations.
Parentingstatusand maritalstatusinteractin Multiple classificationanalysis (MCA) was
theireffecton severaldependentvariables.The used to calculatemean scores on the dependent
effects of divorce on health behaviors are variables for each marital/parenting category,
sometimesattenuated or accentuated,depending adjusting for the effects of age, education,
on parentingstatus. Divorced persons living income, and race. Scores for men and for
apartfromtheirchildrenare significantly more women are presentedseparately.These results
likely to smoke marijuana (p ' .05) and to suggest that marriageand parentingrelation-
drive an automobile afterconsumingalcohol ships work togetherto deter health-compro-
(p c .05). Divorced persons living with their misingbehaviors.
children,however,are significantly less likely Maritalstatusgroupsare differentiated more
to experiencealcohol problems(p ' .001). clearly for men than for women; the married
exhibit the lower rates of negative health
behaviors, and the divorced, the higherrates
OtherIndependentVariables (see Table 2). A rankingof theseninecategories
reveals that overall, marriedmen living with
Table 1 demonstrates thatmenare muchmore young childrenare less likely than any other
likely than women to engage in health- categoryof men to engage in negativehealth
compromisingbehaviors,a findingwell docu- behaviors,a findingwhich supportsthe notion
mentedin previous research(Waldron 1982). thatthe highestlevels of social integration are
Differencesbetweenblacks and whitesare not characterizedby the lowest levels of health-
usually significant;blacks are more likely to compromising behavior. Although divorced
experience drinkingproblems but to exhibit men as a whole exhibit very high levels of
lower scores on the risk-takingbehaviorscale. negativehealthbehaviors,menlivingwiththeir
Income has littleimpact on health-compromi-children exhibit the lowest rates within the
singbehaviors;educationhas a positiverelation- divorcedstatus.Among widowed men, parent-
shipto marijuanause and to an orderlylifestyle, ing statusdifferences are minimal.

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FAMILY STATUS AND HEALTH BEHAVIORS 315

TABLE 2. Mean Scores on Risk-takingfor Men-Multiple ClassificationAnalysis Adjusted for Age,

Race, Education, Income
Drinking Risk- Orderly
Marijuana problem Drinking/ Substance taking lifestyle
use scale driving abuse/coping scale scale
GrandMean: .05 .49 .47 .16 .46 2.07
Married:
Childhome .00 .35 .29 .13 .40 2.10
Childaway .07 .47 .47 .14 .45 2.28
Childless .08 .59 .27 .06 .42 2.36
Divorced:
Childhome .12 .46 .94 .25 .66 1.72
Childaway .17 1.00 .97 .32 .65 1.84
Childless .01 .72 1.26 .28 .72 1.67
Widowed:
Childhome .04 .69 .45 .14 .56 1.88
Childaway .08 .61 .54 .18 .41 1.94
Childless .08 .34 .60 .27 .53 1.73
F-Value 6.20 3.74 9.58 3.08 1.60 4.46
Significance .000 .000 .000 .002 .12 .000

The extent of negative health behaviors DISCUSSION AND CONCLUSION

among women is fairlylow in comparisonto
Gender,social control,and mortality
those among men. Further,the familystatus
variable is significantforonly threeof the six It has been suggestedthat sex and marital
dependentvariables.Women are not differenti- statusdifferences in mortality
are due to gender
ated as clearlyby maritalstatusas are men; the and maritalroles (Gove 1973). These differ-
mortalityevidence suggeststhatmaritalstatus ences occur in part because women provide
more health benefitsto theirspouses than do
has less impacton womenthanon men (House
men. Previous research, however, did not
et al. 1982; Berkmanand Syme 1979; Gove determinewhethergenderand marital
roles are
1973). It followsthatmaritalstatuswould also actuallyassociatedwithmortality-related behav-
have less impacton women's healthbehaviors iors,nordid itdetermine theprocessesby which
thanon men's. Women are also less differenti- marital roles affect health behaviors. The
ated by parentingstatusthanare men. presentfindingsindicatethat gender, marital,

TABLE 3. Mean Scores on Risk-takingfor Women-Multiple ClassificationAnalysis Adjusted for Age,

Race, Education, Income
Drinking Risk- Orderly
Marijuana problem Drinking/ Substance taking lifestyle
use scale driving abuse/coping scale scale
GrandMean: .02 .09 .19 .10 .43 1.94
Married
Childhome .00 .08 .20 .10 .36 1.90
Childaway .05 .05 .10 .06 .38 2.16
Childless .10 .02 .09 .11 .36 2.10
Divorced:
Childhome -.01 .15 .25 .17 .69 1.49
Childaway .03 .14 .36 .14 .68 2.07
Childless .06 .25 .31 .18 .41 2.35
Widowed:
Childhome .03 .14 .14 .01 .53 2.07
Childaway .06 .03 .11 .08 .42 2.21
Childless .06 .25 .02 .00 .50 1.98
F-Value 4.83 .74 .75 1.26 2.14 3.90
Significance .000 .65 .65 .26 .03 .000

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316 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

and parenting rolesare associatedwithmortality- healthrisksamong youngerpopulations,while

relatedbehaviors. routinehealth-maintenance behaviorsare a more
Marital status is associated with negative appropriate study focus of social control
health behaviors;the marriedhave the lowest among older persons. With advancing age,
rates of negative health behaviors, and the routine health concerns become increasingly
divorced, the highestrates. Marital status is relevant. In addition, in later life health
somewhatmore importantto health behaviors problemsroutinelydevelop which requirethe
than is parenting status. Parenting status, individualto initiatenew healthbehaviors(e.g.
however,also has a deterrent effecton health- diet modifications). Social ties, especially
compromisingbehaviors. This deterrentvalue with spouses and adult children,can playqijan
dependsmoreon thepresenceof childrenin the importantsocial control role for the older
home than simply on having had children. person in affecting routine health behav-
Althoughthe effectsof parentingstatusappear iors.
to be similarformenand forwomen,theeffects
of maritalstatuson healthbehaviorssometimes
differby sex; the unmarriedstate is more Whichrelationshipsshouldbe examined?
detrimentalto men's health behaviorsthan to
women's. Studies of social ties and well-beingusually
This studyprovidesa theoreticalframework considera varietyof social relationships-both
(social control)to describehow and whyfamily formal(e.g. church,community)and informal
and gender roles affecthealth behaviors, but (e.g. family,friends)-in predicting well-being.
stopsshortof assessingtheprocesssuggestedby In thisparticularstudythe intimatefamilyties
thatframework.A complete understanding of provided by marriage and parenting were
the interrelationshipsamong familyand gender consideredirrespectiveof otherpossible social
roles, healthbehaviors,and healthrequiresan ties. The mechanismsby which marriageand
analysis of social controlprocesses over time. parentingaffecthealth may differfromthose
The ideal study would include a prospective providedby othersources of social integration
design, with a focus on the process of social (e.g. employment, religion,friendships). Litwak
controlbothbeforeand afterthe transition into (1985) suggeststhatformaland informalsocial
(or outof) maritaland parenting roles. Measure- ties play complementary roles in contributing
to
mentof thisprocess,forexample,could involve physical health. Future research should
determininghow often spouses or children identifyand weigh the importanceof various
remindor tell a respondentto engage in various sources of social contact, as well as the
health behaviors (a form of direct social mechanisms by which those sources affect
control).This design would reveal whetheran well-being.
actual process of social control occurs and The present findings cannot be read as
whetherthereare sex differences in the receipt providing conclusive support for the social
of social control. The issue of selection bias control hypothesis. Even so, the findings
wouldalso be addressedby examiningchangein conformto predictionsthat are made by the
healthbehaviorsin correspondencewith entry hypothesis.It appearsthatsocial integration via
into or exit from marriageand parenting.If marriageand parenthoodhas an inhibiting effect
pre-existingfactorsare responsiblefor health on health-compromising behavior. Social con-
behaviors, family role transitionsshould not trol is only one possible mechanismby which
contributeto change in health behavior over social integrationis linked to mortality.To
time. alleviatethedoubtsposed by selectionbias and
to understandmore fullyhow social relation-
ships affecthealth,we must examine the four
Whichhealthbehaviorsshould be examined? typesof potentialmechanismslinkingsocial ties
to healthwhich were mentionedearlierin this
A primaryconcernin addressingthisquestion study. Those mechanisms include personal
is the age of the population.As noted earlier, attributes,situationalfactors,social behavior,
the more deviant,risk-taking behaviorsconsid- and physiologicalresponses. We must specify
ered in this studyare appropriateindicatorsof the mechanismslinkingsocial relationshipsto

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FAMILY STATUS AND HEALTH BEHAVIORS 317

physicaland psychologicalwell-being,both to NOTES

increase our theoreticalunderstandingof the 1. Some formsof social controlmayalso resultin the
constructsof social supportand social integra- encouragement of negativehealth behaviors.An-
tonucci(1985) stressestheneedto focuson negative
tionand to establishan empiricalbase forfuture healthbehaviorsas a resultof involvement
in social
researchand effectiveinterventions. relationships.

APPENDIX A
Dependent Variables
1. OrderlyLifestyleScale. Respondentswere asked to respondyes or no to the followingitems (1 = yes,
0 = no). Additivescores range fromzero to three.Cronbach'salpha= .51.
I tend to lead an orderlylife.
I usually get enough sleep.
I usuallyeat balanced meals.
2. Risk-TakingBehaviorScale. Respondentswere asked to respondyes or no to the followingitems(1 =yes,
o= no). Additivescores range from0 to 5. Cronbach'salpha= .50.
I sometimesget careless and have accidentsaroundthe house, driving,on the job, etc.
I sometimestake risks I shouldn'tsuch as drivingtoo fast or otherthingsthat mightendangerothers.
I've had serious argumentsor fightsat home duringthe past year.
I've had serious argumentsor fightsoutsidethe home duringthe past year.
When I'm reallyupset or have seriousproblems,I get into argumentswith others.
3. SubstanceUse/AbuseWhen Upset. Respondentswere asked to respondyes or no to the followingitems,
which pertainto what theyoftendo when really upset (1 = yes, 0 = no). Scores range from0 to 2.
Take a drink.
Take pills or otherdrugs to calm me down.
4. Drinkingand DrivingFrequency.Respondentswho drinkwere asked: How manytimesin the past month
have you drivena car afteryou've had threeor more drinks?Scores range from0-3.
(0) None
(1) One time
(2) 2-3 times
(3) 4 or more times
5. DrinkingProblem Scale. Respondentswere asked to respondyes (1) or no (0) to the followingthree
items. Scores range from0 to 2. Cronbach'salpha= .66.
During the past year, did you oftenend up drinkingmore than you plannedto drink?
Duringthepastyear,did youfailto do someof thethingsyoushouldhavedonebecauseof drinking?
Duringthe past year, have you thought,or has someonetold you, thatyourdrinkingwas possiblyhurting
your health?
wereaskediftheyhad usedmarijuanain thepastmonth(1 = yes,0 = no).
6. MarijuanaUse. Respondents

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318 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

APPENDIX B
Correlations,Means, and Standard Deviations of Variables (N =1,826)
1 2 3 4 5 6 7 8 9 10 11 12 13

1. Orderlylifestyle 1.00
2. Risk-takingbehavior - .15 1.00
3. Substanceabuse/coping -.05 .20 1.00
4. Drinking/driving -.05 .10 .13 1.00
5. Drinkingproblem -.14 .25 .31 .23 1.00
6. Marijuanause -.11 .19 .12 .14 .19 1.00
7. Maritalstatus -.07 .00 .09 .07 .18 .03 1.00
8. status
Parenting -.02 -.03 -.01 -.09 -.07 -.14 -.14 1.00
9. Sex .06 .04 .08 .26 .20 .07 .00 -.09 1.00
10. Age .23 -.31 .00 -.13 -.09 -.24 .28 .03 .11 1.00
11. Education .00 .09 .03 .05 -.07 .12 -.19 .00 -.01 -.36 1.00
12. Income .01 .07 .00 .03 - .08 .03 - .37 .10 .07 - .27 .47 1.00
13. Race -.07 -.02 .00 -.02 .10 .04 .09 .00 .01 -.04 -.16 -.17 1.00
MEAN 2.01 .44 .14 .31 .35 .04 .33 .84 .51 9.42 3.71 10.19 .15
STANDARD DEVIATION 1.00 .80 .37 .76 .73 .19 .47 .37 .50 3.98 1.55 4.50 .36

Variable Values: Sex: 0 = Female, 1 = Male; Race: 0 = White, 1 = Non-white;Marital status:0 = Married,
1 = Unmarried;Parentingstatus:0 = Nonparent,1 = Parent.

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