A fundamental gap remains in understanding the relationship between different types of financial strain (asset loss, income loss, credit card and medical debt) and mental and physical health outcomes. Continued existence of this gap represents an important problem because the experience of cumulative financial strain and stressful life events (e.g., job loss, foreclosure, bankruptcy) significantly increases the risk of developing adverse mental and physical health illnesses, a situation that is particularly exacerbated in late-life. Additionally, the economic crisis of 2008 altered the financial well-bein of millions of older Americans who faced significant financial strains, including large medical bils and social hardships such as frayed support networks. The long-term goal is to determine the extent of the association between financial strain, and mental and physical health outcomes and to better understand the complete portfolio of the financial status and health trajectories of olde persons in the U.S. The objective of this application is to identify critical changes in trends in health status over time and to provide new and potentially important insights into an important contributing factor in America's health, namely financial strain. My central hypothesis is that the extent of financial strain is a strong independent predictor of adverse mental health and physical health conditions for older women, African Americans and Latino's. This hypothesis has been formulated on the basis of preliminary data produced in manuscript by the applicant and also guided by the stress process and cumulative (dis)advantage theories. This hypothesis will be tested by pursuing four specific aims: 1) determine the extent to which financial strain influences mental and physical health; 2) determine the extent to which social resources (support and social connectedness)function to modify the relationship between financial strain and adverse mental and physical health; 3) determine the potential influence of broad economic conditions on the relationship between incident financial strain and mental and physical health, particularly within the framework of how macroeconomic context (Great Recession vs. non-recessionary periods) affects subsequent health for older Americans; and 4) determine the extent to which long-term trajectories of mental and physical health (over 12 year period) are associated with changes in financial strain particularly within the conceptual framework of how health trajectories have been affected by the Great Recession of 2008 net of individual financial strain and other salient stressful life events. The approach is innovative because it capitalizes upon a natural experiment of economic history which showed that profound economic changes took place from 2008 to 2010 in terms of job losses, bankruptcies and foreclosures. The proposed research is significant because it is expected to identify key elements of financial strain associated with adverse mental and physical health, and their differential effects by race and gender, leading to a better understanding of stress-based influences on health disparities. Ultimately, such knowledge has the potential to provide insight into the future financial security of older Americans that will help reduce the disparities in health. The proposed research is relevant to public health because it aims to improve our understanding of the complex and unexplored relationship between financial strain, stressful life events and social networks on mental and physical health outcomes. The findings have the potential to inform policy makers of the consequences of the 2008 recession. Thus, the prosed research is relevant to the part of NIH's mission that pertains to developing fundamental knowledge that will help to reduce the burden of human disability.

Public Health Relevance

This study examines the relationship between financial strain, stressful life events, social resources and adverse mental and physical health on older adults and the extent to which social networks modifies these relationships. The study also examines the mental and physical health trajectories of adults associated with changes in financial strain by economic condition: before and after the recession of 2008.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Scientist Development Award - Research & Training (K01)
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Neuroscience of Aging Review Committee (NIA)
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Phillips, John
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University of Washington
Schools of Social Welfare/Work
United States
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Marshall, Gillian L; Tucker-Seeley, Reginald (2018) The association between hardship and self-rated health: does the choice of indicator matter? Ann Epidemiol 28:462-467
Marshall, Gillian L; Baker, Tamara A; Song, Chiho et al. (2018) Pain and Hardship Among Older Men: Examining the Buffering Effect of Medicare Insurance Coverage. Am J Mens Health 12:1439-1449
Marshall, Gillian L; Thorpe Jr, Roland J; Szanton, Sarah L (2017) Material Hardship and Self-Rated Mental Health among Older Black Americans in the National Survey of American Life. Health Soc Work 42:87-95
Magwene, Elena M; QuiƱones, Ana R; Marshall, Gillian L et al. (2017) Older adults rate their mental health better than their general health. J Public Health Res 6:967
Kahana, Eva; Lee, Jeong Eun; Kahana, Boaz et al. (2015) Patient Planning and Initiative Enhances Physician Recommendations for Cancer Screening and Prevention. J Fam Med Community Health 2: