Over 60 years ago, Selye1 recognized the paradox that the physiologic systems activated by stress can not only protect and restore but also damage the body. What links these seemingly contradictory roles? How does stress influence the pathogenesis of disease, and what accounts for the variation in vulnerability to stress-related diseases among people with similar life experiences? How can stress-induced damage be quantified? These and many other questions still challenge investigators. This article reviews the long-term effect of the physiologic response to stress, which I refer to as allostatic load.2 Allostasis — the ability to achieve stability through change3 — . . .

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Protective and Damaging Effects of Stress Mediators

A Treatise on the Family. G. S. Becker. Cambridge, MA: Harvard University Press. 1981. Gary Becker is one of the most famous and influential economists of the second half of the 20th century, a fervent contributor to and expounder of the University of Chicago free-market philosophy, and winner of the 1992 Nobel Prize in economics. Although any book with the word "treatise" in its title is clearly intended to have an impact, one coming from someone as brilliant and controversial as Becker certainly had such a lofty goal. It has received many article-length reviews in several disciplines (Ben-Porath, 1982; Bergmann, 1995; Foster, 1993; Hannan, 1982), which is one measure of its scholarly importance, and yet its impact is, I think, less than it may have initially appeared, especially for scholars with substantive interests in the family. This book is, its title notwithstanding, more about economics and the economic approach to behavior than about the family. In the first sentence of the preface, Becker writes "In this book, I develop an economic or rational choice approach to the family." Lest anyone accuse him of focusing on traditional (i.e., material) economics topics, such as family income, poverty, and labor supply, he immediately emphasizes that those topics are not his focus. "My intent is more ambitious: to analyze marriage, births, divorce, division of labor in households, prestige, and other non-material behavior with the tools and framework developed for material behavior." Indeed, the book includes chapters on many of these issues. One chapter examines the principles of the efficient division of labor in households, three analyze marriage and divorce, three analyze various child-related issues (fertility and intergenerational mobility), and others focus on broader family issues, such as intrafamily resource allocation. His analysis is not, he believes, constrained by time or place. His intention is "to present a comprehensive analysis that is applicable, at least in part, to families in the past as well as the present, in primitive as well as modern societies, and in Eastern as well as Western cultures." His tone is profoundly conservative and utterly skeptical of any constructive role for government programs. There is a clear sense of how much better things were in the old days of a genderbased division of labor and low market-work rates for married women. Indeed, Becker is ready and able to show in Chapter 2 that such a state of affairs was efficient and induced not by market or societal discrimination (although he allows that it might exist) but by small underlying household productivity differences that arise primarily from what he refers to as "complementarities" between caring for young children while carrying another to term. Most family scholars would probably find that an unconvincingly simple explanation for a profound and complex phenomenon. What, then, is the salient contribution of Treatise on the Family? It is not literally the idea that economics could be applied to the nonmarket sector and to family life because Becker had already established that with considerable success and influence. At its core, microeconomics is simple, characterized by a belief in the importance of prices and markets, the role of self-interested or rational behavior, and, somewhat less centrally, the stability of preferences. It was Becker's singular and invaluable contribution to appreciate that the behaviors potentially amenable to the economic approach were not limited to phenomenon with explicit monetary prices and formal markets. Indeed, during the late 1950s and throughout the 1960s, he did undeniably important and pioneering work extending the domain of economics to such topics as labor market discrimination, fertility, crime, human capital, household production, and the allocation of time. Nor is Becker's contribution the detailed analyses themselves. Many of them are, frankly, odd, idiosyncratic, and off-putting. …

A Treatise on the Family

Over the last several decades, epidemiological studies have been enormously
successful in identifying risk factors for major diseases However, most of this
research has focused attention on risk factors that are relatively proximal causes of
disease such as diet, cholesterol level, exercise and the like We question the
emphasis on such individually-based risk factors and argue that greater attention
must be paid to basic social conditions if health reform is to have its maximum
effect in the time ahead There are two reasons for this claim First we argue that
individually-based risk factors must be contextualized, by examining what puts
people at risk of risks, if we are to craft effective interventions and improve the
nation's health Second, we argue that social factors such as socioeconomic status
and social support are likely 'fundamental causes" of disease that, because they
embody access to important resources, affect multiple disease outcomes throughmultiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change Without careful attention to these
possibilities, we run the risk of imposing individually-based intervention strategies
that are ineffective and of missing opportunities to adopt broad-based societal
interventions that could produce substantial health benefits for our citizens

Social Conditions as Fundamental Causes of Disease

I review existing knowledge, unanswered questions, and new directions in research on stress, coping resource, coping strategies, and social support processes. New directions in research on stressors include examining the differing impacts of stress across a range of physical and mental health outcomes, the "carry-overs" of stress from one role domain or stage of life into another, the benefits derived from negative experiences, and the determinants of the meaning of stressors. Although a sense of personal control and perceived social support influence health and mental health both directly and as stress buffers, the theoretical mechanisms through which they do so still require elaboration and testing. New work suggests that coping flexibility and structural constraints on individuals' coping efforts may be important to pursue. Promising new directions in social support research include studies of the negative effects of social relationships and of support giving, mutual coping and support-giving dynamics, optimal "matches" between individuals' needs and support received, and properties of groups which can provide a sense of social support. Qualitative comparative analysis, optimal matching analysis, and event-structure analysis are new techniques which may help advance research in these broad topic areas. To enhance the effectiveness of coping and social support interventions, intervening mechanisms need to be better understood. Nevertheless, the policy implications of stress research are clear and are important given current interest in health care reform in the United States.

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Stress, coping, and social support processes: where are we? What next?

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

Although research has clearly established that low family income has negative impacts on children's cognitive skills and social–emotional competence, less often is a family's experience of material hardship considered. Using the Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999 (N=21,255), this study examined dual components of family income and material hardship along with parent mediators of stress, positive parenting, and investment as predictors of 6-year-old children's cognitive skills and social–emotional competence. Support was found for a model that identified unique parent-mediated paths from income to cognitive skills and from income and material hardship to social–emotional competence. The findings have implications for future study of family income and child development and for identification of promising targets for policy intervention.

Income is not enough: incorporating material hardship into models of income associations with parenting and child development.

In spite of employed married women performing approximately twice as much hosework as their husbands, the majority of women believe this situation to be fair This article investigates the sources and consequences of employed wives' perceptions of fairness in the division of housework The findings support a social exchange explanation: women who have fewer alternatives to marriage and less economic resources are more likely to view a given division of housework as fair, while women with more alternatives view the same division as unjust Also, women who perceive an unequal situation as unfair experience lower psychological well-being

https://www.jstor.org/stable/pdfplus/2782078.pdf

Relative Fairness and the Division of Housework: The Importance of Options

This article proposes a social causation explanation for the association between SES and depression/distress. The model links SES, occupational direction, control, and planning (DCP), personality factors, and depression/distress in a causal sequence. The data to test the social causation model against alternative, social selection models are derived from samples of psychiatric patients and community residents in Washington Heights, New York City. The key factor of DCP is operationalized using ratings from the Dictionary of Occupational Titles. The results support the social causation model and cannot be accounted for by several tests derived from social selection models. Thus the results increase the plausibility of the social causation model and suggest the need for further research on the links between occupational conditions and mental disorder.

Socioeconomic Status and Depression: The Role of Occupations Involving Direction, Control, and Planning

We previously reported an inverse relation between parietal cerebral blood flow and years of education in Alzheimer's disease (AD) patients matched for clinical severity. This suggested that the clinical manifestation of advancing AD pathology is delayed in patients with higher educational attainment. Other aspects of life experience may also provide a reserve against the clinical expression of AD. To test this hypothesis, we classified the primary life-time occupations of 51 AD patients using the Dictionary of Occupational Titles, published by the US Department of Labor, and derived six factor scores describing intellectual, interpersonal, and physical job demands. Regional cerebral blood flow was measured using the xenon-133 inhalation method. After controlling for age, clinical dementia severity, and education, there was less relative perfusion in the parietal region in subjects whose occupations were associated with higher interpersonal skills and physical demands factor scores. We conclude that independent of education, aspects of occupational experience may provide a reserve that delays the clinical manifestation of AD.

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Relationship between lifetime occupation and parietal flow Implications for a reserve against Alzheimer's disease pathology

Current research on the effects of wives' employment on their well-being focuses on the determinants of those effects. Most studies have used a gender model that concentrates on family conditions as mediators. In contrast, studies of the effects of employment on men typically use a job model and focus on work rather than family conditions as determinants. To understand fully the impact of employment on women, these models should be combined. We predict that certain work and family conditions interact, specifically, that the degree of control at work moderates the effects of demands in the family. Using two data sets on community mental health, we have found some support for this hypothesis.

Mary Clare Lennon

Papers

Income is not enough: incorporating material hardship into models of income associations with parenting and child development.

Relative Fairness and the Division of Housework: The Importance of Options

Socioeconomic Status and Depression: The Role of Occupations Involving Direction, Control, and Planning

Relationship between lifetime occupation and parietal flow Implications for a reserve against Alzheimer's disease pathology

Women and mental health: the interaction of job and family conditions.