Spouse Employment Research Articles

Spousal Employment and Intra-Household Bargaining Power

This paper considers the relationship between work status and decision-making power of the head of household and his spouse. I use household fixed effects models to address the possibility that spousal work status may be correlated with unobserved factors that also affect bargaining power within the home. Consistent with the hypothesis that greater economic resources yield greater bargaining power, I find that the spouse of the head of household is more likely to be involved in decisions when she has been employed. Similarly, the head of household is less likely to be the sole decision-maker when his spouse works.

International Medical Graduates: A Cohort Study of Key Informant Perspectives

An Australian wide shortage of doctors has led to an increased reliance on International Medical Graduate (IMG) recruitment. However, there is very little research regarding the acculturation of IMGs as they reside in the rural Tasmanian context. This paper explores from the perspective of IMG informants, the experiences and challenges of IMGs living and working in rural and remote Tasmania and how it informs the acculturation process. It identifies the barriers facing IMGs as they work and live in Tasmanian communities. It is part of a larger doctoral study looking at IMGs in Tasmania. The study adopted a qualitative research approach. Twenty-three semi-structured interviews were conducted with IMG informants in the North, South and North West of Tasmania. Informants were recruited through purposive snowball sampling. The findings indicate that Tasmanian based IMGs encounter both professional and social challenges. These challenges include vulnerability due to fear of job security, and loss of status, discrimination and communication challenges within the workplace. Additional challenges include spouse employment, obtaining high quality academic access for children, and cultural and religious connectivity. These challenges influence IMGs and their families to stay or relocate. In addition, a number of identified needs have been identified to improve retention of IMGs within Tasmania. The study adds to existing knowledge and identifies three factors which further determine the retention of IMGs. These factors include, job opportunities, vocational training and greater commensurate support provided to IMGs and their families.

Chimeric Antigen Receptor Modified T Cells Directed Against CD19 (CTL019 cells) Have Long-Term Persistence and Induce Durable Responses In Relapsed, Refractory CLL

BackgroundChimeric antigen receptors (CARs) combine the antigen recognition domain of an antibody with intracellular signaling domains into a single chimeric protein. CD19 is an ideal target for CARs since expression is restricted to normal and malignant B cells. Inclusion of the CD137 (4-1BB) signaling domain results in potent antitumor activity and in-vivo persistence of anti-CD19 CAR-modified T cells in mice. Lentiviral transduction into T cells facilitates strong surface expression of the CAR. We reported anti-tumor activity of CAR-modified autologous T cells targeted to CD19 (CTL019 cells) in 3 patients (pts) with CLL with relatively short follow up (Porter, et al NEJM 2011; Kalos et al Sci Trans Med 2011). We now report on outcomes and longer follow up from our pilot study treating 14 pts with relapsed, refractory CLL. MethodsAutologous T cells collected by leukapheresis were transduced with a lentivirus encoding anti-CD19 scFv linked to 4-1BB and CD3-ζ signaling domains. Gene-modified T cells were expanded and activated ex-vivo by exposure to anti-CD3/CD28 beads. Pts had to have relapsed or persistent disease after at least 2 previous treatments (1 prior therapy for patients with p53 mutation) and progressed at least within 2 years of their last therapy. All pts received lymphodepleting chemotherapy ending 3-5 days before T cell infusion. The target dose of cells was 5 x 109 mononuclear cells with an expected transfection efficiency of 10-40% (total CTL019 dose 5x108 – 2 x 109 total cells). Cell infusions were planned over 3 days (10% on day 1, 30% of day 2, and 60% on day 3) but were held for fevers or other toxicity. Results14 patients were treated on this pilot study including 12 men and 2 women with a median age of 67 (51-78). Pts had received a median of 4 prior therapies (1-10) and 6 pts had a mutation of p53. All pts had active disease at the time of CTL019 cell infusion. Lymphodepleting chemotherapy was Fludarabine/cyclophosphamide (3), pentostatin/cyclophosphamide (5), or bendamustine (6). A median of 7.5 x 108 total cells (range 1.7-50), corresponding to 1.4 x 108(range 0.14-5.9) genetically modified cells were infused over day 0, 1 and 2.There were no infusional toxicities >grade 2 though 6 pts developed fevers within 24 hrs of infusion #1 (3) or #2 (3) and did not receive additional CTL019 cells. Median follow-up as of July 15, 2013 was 9.4 mo (4-35) for all pts and 16 mo (5-35) for the 8 responding pts. 3 patients (21%) achieved a CR (follow-up 11, 34, and 35 mo), 5 (36%) achieved a PR (med follow up 11 mo, range 5-27 mo) and 6 (43%) had no response, for an overall major response rate of 57%. 2 of 5 pts with a PR progressed 4 mo after infusion with CD19+ CLL, and no patient with a CR has relapsed.Comparing responders to non-responders, there has been no association between response and patient age (66 vs 67 yrs), number of prior therapies (median 4 each), cell dose (7.5 vs 11.5 x 108MNC), or p53 mutation (3/8 vs 3/6, p>0.9), implying that within the dose ranges studied, there is no obvious dose:response relationship.All responding pts developed a delayed cytokine release syndrome (CRS), concurrent with peak T cell expansion, and was manifested by fever, and variable degrees of nausea, anorexia, myalgias, and transient hypotension and hypoxia. Detailed cytokine analysis showed marked increases from baseline values of IL6, IFN-γ, and IL2R, while no significant elevation in systemic levels of TNFα or IL2 were observed. The CRS required intervention in 5 patients. Treatment was initiated for hemodynamic or respiratory instability and was rapidly reversed in all cases with corticosteroids in 1 pt and the IL6-receptor antagonist tocilizumab (4 pts); 3 of these 4 pts also received 1 or 2 doses of corticosteroids. Persistence of CTL019 cells has been detected by flow cytometry in all 6 pts with ongoing responses 5-35 months after infusion, and all patients have sustained B cell aplasia without any unusual infectious complications. ConclusionsCTL019 cells are autologous T cells genetically engineered to express an anti-CD19 scFv coupled to 4-1BB/CD3-ζ signaling domains. These cells can undergo robust in-vivo expansion and can persist for at least 3 yrs. CTL019 therapy is associated with a significant CRS that responds rapidly to anti-cytokine treatment. CTL019 cells can induce potent and sustained responses (8/14) for patients with advanced, relapsed and refractory CLL regardless of p53 mutation status. Disclosures:Porter:Novartis: Patents & Royalties, Research Funding; Genentech: Spouse employment, Spouse employment Other. Off Label Use: CTL019 cells to treat CLL. Kalos:Adaptive biotechnologies: Member scientific advisory board , Member scientific advisory board Other; Novartis corporation: CART19 technology, CART19 technology Patents & Royalties. Grupp:Novatis: Research Funding. Lledo:Novartis: Research Funding. Chew:Novartis: Patents & Royalties. Zheng:Novartis: Patents & Royalties. Levine:Novartis: cell and gene therapy IP, cell and gene therapy IP Patents & Royalties. June:Novartis: Patents & Royalties, Research Funding.

Randomized, Phase II Dose Optimization Study Of Chimeric Antigen Receptor Modified T Cells Directed Against CD19 (CTL019) In Patients With Relapsed, Refractory CLL

Randomized, Phase II Dose Optimization Study Of Chimeric Antigen Receptor Modified T Cells Directed Against CD19 (CTL019) In Patients With Relapsed, Refractory CLL

Gender Differences in Salary in a Recent Cohort of Early-Career Physician–Researchers

Studies have suggested that male physicians earn more than their female counterparts. The authors examined whether this disparity exists in a recently hired cohort. In 2010-2011, the authors surveyed recent recipients of National Institutes of Health (NIH) mentored career development (i.e., K08 or K23) awards, receiving responses from 1,275 (75% response rate). For the 1,012 physicians with academic positions in clinical specialties who reported salary, they constructed linear regression models of salary considering gender, age, race, marital status, parental status, additional doctoral degree, academic rank, years on faculty, specialty, institution type, region, institution NIH funding rank, K award type, K award funding institute, K award year, work hours, and research time. They evaluated the explanatory value of spousal employment status using Peters-Belson regression. Mean salary was $141,325 (95% confidence interval [CI] 135,607-147,043) for women and $172,164 (95% CI 167,357-176,971) for men. Male gender remained an independent, significant predictor of salary (+$10,921, P < .001) even after adjusting for specialty, academic rank, work hours, research time, and other factors. Peters-Belson analysis indicated that 17% of the overall disparity in the full sample was unexplained by the measured covariates. In the married subset, after accounting for spousal employment status, 10% remained unexplained. The authors observed, in this recent cohort of elite, early-career physician-researchers, a gender difference in salary that was not fully explained by specialty, academic rank, work hours, or even spousal employment. Creating more equitable procedures for establishing salary is important.

Racial and Ethnic Differences in Nonwage Compensation

Previous research has found that, after controlling for test scores, measured black–white wage gaps are small, but unemployment gaps remain large. This article complements this previous research by examining the incidence of employer‐provided benefits from the same premarket perspective. However, marriage rates differ substantially by race, and the possibility of health insurance coverage through a spouse's employer therefore distorts how the distribution of benefits available in the market to an individual is expressed in the distribution of benefits received. Two imputation strategies are used to address this complication. The evidence suggests that benefit availability gaps are small.

Does employer-provided health insurance constrain labor supply adjustments to health shocks? New evidence on women diagnosed with breast cancer

Employment-contingent health insurance may create incentives for ill workers to remain employed at a sufficient level (usually full-time) to maintain access to health insurance coverage. We study employed married women, comparing the labor supply responses to new breast cancer diagnoses of women dependent on their own employment for health insurance with the responses of women who are less dependent on their own employment for health insurance, because of actual or potential access to health insurance through their spouse's employer. We find evidence that women who depend on their own job for health insurance reduce their labor supply by less after a diagnosis of breast cancer. In the estimates that best control for unobservables associated with health insurance status, the hours reduction for women who continue to work is 8 to 11% smaller. Women's subjective responses to questions about working more to maintain health insurance are consistent with the conclusions from observed behavior.

How Do the Disabled Cope While Waiting for SSDI?

The wait time for a Social Security Disability Insurance (SSDI) award varies from a few months to several years. Little is known about how applicants fund their consumption during this period. Using the Survey of Income and Program Participation (SIPP) linked to the Social Security Administration’s 831 file, this study examines the use of seven different coping strategies on which applicants may rely for resources, including government transfers, intra-family resources, other financial resources, and locational changes. Our results suggest that applicants use some coping strategies more frequently with longer application duration, especially spousal employment, the Supplemental Nutrition Assistance Program (SNAP) and the Supplemental Security Income (SSI) program for the disabled and children. They are also less likely to report receiving Unemployment Insurance benefits, changing their address, and owning a home. Together, these results suggests that some of the studied coping strategies are an important part of funding consumption during the application process, either by sustaining ongoing applications or by making it easier to file an appeal of an initially denied application.

Exercise, physical activity, and exertion over the business cycle

Shifts in time and income constraints over economic expansions and contractions would be expected to affect individuals' behaviors. We explore the impact of the business cycle on individuals' exercise, time use, and total physical exertion, utilizing information on 112,000 individual records from the 2003–2010 American Time Use Surveys. In doing so, we test a key causal link that has been hypothesized in the relation between unemployment and health, but not heretofore assessed. Using more precise measures of exercise (and other activities) than previous studies, we find that as work-time decreases during a recession, recreational exercise, TV-watching, sleeping, childcare, and housework increase. This, however, does not compensate for the decrease in work-related exertion due to job-loss, and total physical exertion declines. These effects are strongest among low-educated men, which is validating given that employment in the Great Recession has declined most within manufacturing, mining, and construction. We also find evidence of intra-household spillover effects, wherein individuals respond to shifts in spousal employment conditional on their own labor supply. The decrease in total physical activity during recessions is especially problematic for vulnerable populations concentrated in boom-and-bust industries, and may have longer-term effects on obesity and related health outcomes.

Remarital Chances, Choices, and Economic Consequences: Issues of Social and Personal Welfare

Many divorced women experience a significant decline in finan cial, social, physical, and psychological well-being following a divorce. Using data from the NLSY79 (n= 2,520) we compare welfare recipients, mothers, and impoverished women to less marginalized divorcees on remarriage chances. Furthermore, we look at the kinds of men these women marry by focusing on the employment and education of new spouses. Finally, we address how remarriage and spousal quality (as defined by education and employment) impact economic well-being after divorce. Our results show that remarriage has positive economic effects, but that is dependent upon spousal quality. However, such matches are rare among divorced women with children and in poverty. The implications of our results for social welfare issues are discussed.

Does Specialization Explain Marriage Penalties and Premiums?

Married men's wage premium is often attributed to within-household specialization: men can devote more effort to wage-earning when their wives assume responsibility for household labor. We provide a comprehensive evaluation of the specialization hypothesis, arguing that, if specialization causes the male marriage premium, married women should experience wage losses. Furthermore, specialization by married parents should augment the motherhood penalty and the fatherhood premium for married as compared to unmarried parents. Using fixed-effects models and data from the NLSY79, we estimate within-gender differences in wages according to marital status and between-gender differences in the associations between marital status and wages. We then test whether specialization on time use, job traits, and tenure accounts for the observed associations. Results for women do not support the specialization hypothesis. Childless men and women both receive a marriage premium. Marriage augments the fatherhood premium but not the motherhood penalty. Changes in own and spousal employment hours, job traits, and tenure appear to benefit both married men and women, although men benefit more. Marriage changes men's labor market behavior in ways that augment wages, but these changes do not appear to occur at the expense of women's wages.

"Crossing Paths: The Nexus of Gender, Spousal Employment, and Professional Identity Creation"

As traditional marriages (i.e., working men with stay-at-home wives) become more rare, both men’s and women’s professional identities and career opportunities are being challenged, revised and reconstructed. In this symposium we explore the nexus of gender, professional identity and the work-home boundary. All four papers begin with the premise that the employment status of couples is an important explanatory variable in organizational studies – in this way they embrace the permeability of the work-home boundary and the shifting cultural image of the masculine breadwinner that is tied to traditional marriage. Ultimately, the research presented in this symposium aims to enhance gender equality at work by challenging expectations based on spousal employment status and help both men and women feel fulfilled in their work and home relationships. Breadwinners and Power Couples: Men’s Professional Identities and Their Wives’ Careers Presenter: Erin Marie Reid; Harvard U. Ideal Leaders?: How Family Involvement and Spousal Employment Shape Employees’ Leadership Behaviors Presenter: Tracy L. Dumas; The Ohio State U. Presenter: Taryn Lyn Stanko; U. of Oregon Do Women Suffer at Work when Men Coworkers Suffer at Home? Presenter: Lakshmi Ramarajan; Harvard U. Presenter: Jennifer L. Berdahl; U. of Toronto Can A Domestic Traditionalist by Night be an Organizational Egalitarian by Day? Presenter: Sreedhari D. Desai; U. of North Carolina Presenter: Dolly Chugh; New York U. Presenter: Arthur P. Brief; U. of Utah

Is Fly in/Fly out (FIFO) a viable interim solution to address remote medical workforce shortages?

Geographically remote regions of Australia experience a higher degree of socioeconomic inequality and health inequity, amid poor resourcing and extreme climatic conditions, when compared with their more urban counterparts. Doctors with the knowledge, skills and interest in remote work remain a scarce resource, with only 58 practitioners per 100,000 people versus 196/100,000 in metropolitan areas. Pending the arrival of the full complement of long-term remote medical workforce, an alternative solution that has so far received little attention but could provide near equivalence to resident doctors is the 'fly in/fly out' (FIFO) model. Specifically, where one doctor has a continuous relationship with one town or community, albeit spending their rostered time off away from this location, rather than continuity of service with different doctors each time. In this model, doctors spend a fixed number of days at work geographically remote from their home and families, with logistical support (eg housing, transport) provided, followed by a fixed number of days back at home not working. This provides a the doctor with the benefits of remote clinical work plus guaranteed time off at home, a more acceptable roster than in many remote locations at present. This also avoids the complex issue of experienced doctors having to leave remote areas mid-career for the well-documented reasons of spouse employment and children's education, as well as providing easier access to professional development activities. The author followed this path and remains a FIFO doctor after 7 years of continuous service. For FIFO to be effective, there needs to be a commitment from the sponsoring organisation for short, balanced, flexible, family friendly rosters and a positive organizational structure with effective communication between management and front line staff. Evidence shows that families and children with healthy family functioning, who are able to balance separateness and togetherness and are able to readily adjust when circumstances move from stability through change, and have strong communication skills, cope well with FIFO work. The author's employer actively supports his FIFO work arrangements. Although FIFO presents challenges and is not for everyone, it may be time for organisations providing medical care to remote Australia to further consider this option. Allowing mid-career doctors experienced in remote medicine to continue remote clinical practice when they move to the city for family reasons would provide an immediate benefit to remote communities. Notwithstanding the challenges, perhaps it is time to consider the option of FIFO to address ongoing workforce shortages?

Hiring Residents as Faculty Members: Dancing with the Stars

As a department chair, I am deeply grateful for the efforts of residency program directors and graduate student mentors who nurture and develop residents and graduate students to become future faculty members. It is always hard to let go of individuals in whom you have vested so much, but your legacy grows with each successful placement. From December to April is the crucial recruitment season when residents begin the serious process of interviewing for prospective faculty positions and making employment decisions. I have likened it to “Dancing with the Stars.” Most residents are already “stars,” but the condensed timeline creates stress on school personnel and residency candidates, and some of the prospects miss important steps in the “dance.” Like many of you, I spent endless hours in the ASHP Personnel Placement Service (PPS) venue last December. (Was the meeting actually in New Orleans?) With several of my colleagues, I enjoyed the introductory interviews with many pharmacists who would complete their residencies the following July and who expressed interest in faculty positions. The residents were well-prepared with excellent curriculum vitae, business cards, professional attire, and engaging communication. Most wrote timely and detailed thank you notes after the meeting. In other words, they made an excellent impression. As a newer school, we conducted extensive interviews for pharmacy practice, pharmacy administration, and administrative positions over several months. I believe that just like student pharmacists who are applying to more residency programs because they perceive increased competition, residents are applying to many colleges and schools as they search for faculty positions. For example, 1 future candidate interviewed with 30 programs at PPS, applied to 8 programs, and received interviews with 6 colleges or schools. Residents are scheduling interviews, travel, presentations, and coverage at the practice site, while simultaneously completing residency requirements and dealing with the uncertainty of a potential move, spousal employment, family issues, and licensure in a new state — a challenging time, to be sure. Meanwhile a school must try to balance expertise in practice areas, involve practice site personnel in interviews and decisions, navigate university processes, and prepare to gradually orient new faculty members and integrate them into courses and practice experiences. Some colleges and schools complete their interviews by April and others start them in April. Spring is as crucial (and challenging) to colleges and schools as it is to candidates. The question I pose is whether it is time to establish guidelines and timelines for spring recruitment of residents into academic positions. Generally, they finish residencies at the same time. Is it possible to conclude the “free agency” period with a “draft” by April 15th each year? Match Day is a relief for students interested in residencies. How would a “Decision Day” for faculty positions work? Would a more synchronous timeline allow for better planning and appropriate use of resources? I had mentioned mis-steps in the dance. When individuals are interviewing for multiple positions, they should be encouraged to show proper courtesy and respect to programs who are awaiting a decision on an offer. I think it is inappropriate for colleges and schools to place excessive pressure on candidates for immediate decisions, but it is also not acceptable for candidates to ignore phone calls or e-mails because they are not ready to commit. My suggestion is for advisors and mentors to encourage candidates to complete interviews and responses with the same professionalism that they demonstrated when they began the process. I would advise residents to: (1) Always reply to a communication, even if more time is needed for a decision. (2) Personally communicate by phone with the person who extended the offer. (It is possible to arrange a mutually convenient time by e-mail.) (3) Be civil, courteous, and generous at all times. We all have the same goal for these pharmacy stars: to have professional satisfaction and personal happiness working with a college or school at which they can prosper. When someone I interview and recruit decides to work elsewhere, I am disappointed, but I am happy to have gotten to know the person better. We have shared a dance, and we actually might be partners in the future.

The effects of health shocks on employment and health insurance: the role of employer-provided health insurance

Employment-contingent health insurance (ECHI) has been criticized for tying insurance to continued employment. Our research sheds light on two central issues regarding employment-contingent health insurance: whether such insurance "locks" people who experience a health shock into remaining at work; and whether it puts people at risk for insurance loss upon the onset of illness, because health shocks pose challenges to continued employment. We study how men's dependence on their own employer for health insurance affects labor supply responses and health insurance coverage following a health shock. We use the Health and Retirement Study (HRS) surveys from 1996 through 2008 to observe employment and health insurance status at interviews 2 years apart, and whether a health shock occurred in the intervening period between the interviews. All employed married men with health insurance either through their own employer or their spouse's employer, interviewed in at least two consecutive HRS waves with non-missing data on employment, insurance, health, demographic, and other variables, and under age 64 at the second interview are included in the study sample. We then limited the sample to men who were initially healthy. Our analytical sample consisted of 1,582 men of whom 1,379 had ECHI at the first interview, while 203 were covered by their spouse's employer. Hospitalization affected 209 men with ECHI and 36 men with spouse insurance. A new disease diagnosis was reported by 103 men with ECHI and 22 men with other insurance. There were 171 men with ECHI and 25 men with spouse employer insurance who had a self-reported health decline. Labor supply response differences associated with ECHI-with men with health shocks and ECHI more likely to continue working-appear to be driven by specific types of health shocks associated with future higher health care costs but not with immediate increases in morbidity that limit continued employment. Men with ECHI who have a self-reported health decline are significantly more likely to lose health insurance than men with insurance through a spouse. With the passage of health care reform, the tendency of men with ECHI as opposed to other sources of insurance to remain employed following a health shock may be diminished, along with the likelihood of losing health insurance.

Parental employment and children's body weight: Mothers, others, and mechanisms

A robust body of literature spanning several countries indicates a positive association between maternal employment and child body mass index (BMI). Fewer studies have examined the role of paternal employment. More importantly, little empirical work examines the mechanisms that might explain the relationships between parental employment and children's BMI. Our paper tests the relationship between the cumulative experience of maternal and spouse employment over a child's lifetime and that child's BMI, overweight, and obesity at age 13 or 14. We further examine several mechanisms that may explain these associations. We use data from the U.S. National Longitudinal Survey of Youth (NLSY79) merged mother–child file on cohorts of children who were born during a period of dramatic increase in both childhood obesity and maternal employment. We find that the number of hours that highly-educated mothers work over her child's lifetime is positively and statistically significantly associated with her child's BMI and risk of overweight at ages 13 or 14. The work hours of mothers' spouses and partners, on the other hand, are not significantly associated with these outcomes. Results suggest that, for children of highly-educated mothers, the association between maternal work hours and child BMI is partially mediated by television viewing time.

Work‐family conflict and its antecedents among Iranian operating room personnel

PurposeThe purpose of this paper is to investigate the relationship between work‐family conflict and its antecedent variables. The research's dependent variables include work interference with family (WIF) and family interference with work (FIW). Independent variables consist of work‐related (hours spent at work, role conflict, role ambiguity, supervisor support, and work shifts), family‐related (hours spent with family, marital status, spousal employment, number of children, and age of the youngest child), and demographic (gender, age, tenure, and education) variables.Design/methodology/approachIn total, 333 operating room personnel in ten Iranian hospitals completed a survey questionnaire, which consisted of 38 questions administered to participants in the workplace.FindingsAnalysis of data revealed that among work‐related variables, the role conflict was positively associated with WIF. Supervisor support and working shifts were also weakly related to WIF. No significant relationships were found between family‐related variables and FIW. Among the demographic variables, only gender influenced FIW in a manner that men experienced more FIW than women.Originality/valueThe research findings contribute to understanding work‐family conflict in a new cultural setting. The empirical evidence of work‐family conflict in Iran, among operating room personnel, shows that experiences and antecedents of work‐family conflict vary among diverse cultures and industries. Models of work‐family conflict may need to be modified to reflect the experiences and antecedents that explain work‐family conflict in cultures similar to that of Iran.

Early-Life Mental Disorders and Adult Household Income in the World Mental Health Surveys

Better information on the human capital costs of early-onset mental disorders could increase sensitivity of policy makers to the value of expanding initiatives for early detection and treatment. Data are presented on one important aspect of these costs: the associations of early-onset mental disorders with adult household income. Data come from the World Health Organization (WHO) World Mental Health Surveys in 11 high-income, five upper-middle income, and six low/lower-middle income countries. Information about 15 lifetime DSM-IV mental disorders as of age of completing education, retrospectively assessed with the WHO Composite International Diagnostic Interview, was used to predict current household income among respondents aged 18 to 64 (n = 37,741) controlling for level of education. Gross associations were decomposed to evaluate mediating effects through major components of household income. Early-onset mental disorders are associated with significantly reduced household income in high and upper-middle income countries but not low/lower-middle income countries, with associations consistently stronger among women than men. Total associations are largely due to low personal earnings (increased unemployment, decreased earnings among the employed) and spouse earnings (decreased probabilities of marriage and, if married, spouse employment and low earnings of employed spouses). Individual-level effect sizes are equivalent to 16% to 33% of median within-country household income, and population-level effect sizes are in the range 1.0% to 1.4% of gross household income. Early mental disorders are associated with substantial decrements in income net of education at both individual and societal levels. Policy makers should take these associations into consideration in making health care research and treatment resource allocation decisions.

Generational differences in factors influencing physicians to choose a work location

Canadian medical schools have increased enrolment and recruited more rural students in an effort to address general and rural physician shortages. The success of this approach depends on the recruitment of these newly trained physicians to under-serviced areas. Studies from North America suggest that the career expectations and practice patterns of younger, more recently graduated physicians differ from those of their older counterparts. This study explored the factors that influenced the work location choices of physicians of differing generations, who trained at universities in Saskatchewan, and Newfoundland and Labrador, two Canadian provinces with large rural populations and no community larger than 235 000 population. Semi-structured, qualitative interviews were conducted with physicians who graduated from either the Memorial University of Newfoundland or the University of Saskatchewan. Generation definitions were based on the graduation year. Early-career physicians graduated between 1995 and 1999; mid-career physician graduated between 1985 and 1989; late-career physicians graduated between 1975 and 1979; and end-career physicians graduated between 1965 and 1969. Each physician was asked questions about the number and nature of work location changes over the course of their careers and the factors related to their decision to choose each location. Interview transcripts and notes were analyzed using a thematic analysis approach. Although the study focus was on generational differences, similarities and differences between universities, sexes and specialties (family physicians/GPs vs specialists) were also examined. Recruitment to the provinces was focused on as a whole, because the largest communities in the provinces are small compared with most urban communities. Forty-eight physicians were interviewed, five to nine physicians who graduated in each decade and from each university. The desire to be near family and friends was cited as the primary consideration when choosing a work location, regardless of generation. Likewise, residency training location, the ability to use their skills and knowledge fully, and the quality of recruitment efforts were important considerations in choosing a work location for all physicians. For some, remuneration was very influential in their work location decision; however, many physicians who chose to remain in their smaller 'home' provinces noted the lower cost of living in these provinces. Physicians who graduated in the 1980s and 1990s placed greater emphasis on work-life balance and spouse's employment opportunities than their older generation counterparts. In contrast, physicians who graduated in the 1960s and 1070s highlighted the medical need of the community, and the desire for adventure and to see new places as important. While many factors for choosing a work location appear to be stable over generations, a number of generational differences were found. Younger physicians placed greater emphasis on work-life balance and spouse's employment than older generation physicians. These differences may have important implications for small population regions which may not be able to support physician-spouse pairs or certain subspecialties. Although economic factors have largely been the focus of recruitment and retention initiatives in these provinces, the findings highlight the importance of addressing the needs and expectations of younger generation physicians in order to attract these physicians.

The great recession and unpaid work time in the United States – Does poverty matter?

Using the 2003–12 American Time Use Survey, this paper establishes the presence of poverty-based differences in the changes in household production time of men and women during the Great Recession, contributing to our understanding of the heterogeneous impact of recession on the well-being of individuals. We find that poor men’s unpaid work time increased whereas nonpoor men’s unpaid work time decreased. Among women, only nonpoor women reduced their unpaid work time. We examine the forces behind these changes using the Oaxaca-Blinder decompositions. The decompositions reveal that poverty-based differences can be partially attributed to shifts in the structure of households whereas gender-based differences to shifts in own and spousal employment status. Nevertheless, sizable portions of the changes in unpaid work time remain unexplained by the shifting individual and household characteristics. The analysis of the unexplained portion of the changes supports the assertion that poverty matters to the adjustments in unpaid work time.