19 Marriage and Relationships

What is a “healthy marriage?

There are at least two characteristics that all healthy marriages have in common.

• First, they are mutually enriching, and
• Second, both spouses have a deep respect for each other.

It is a mutually satisfying relationship that is beneficial to the husband, wife and children (if present). It is a relationship that is committed to ongoing growth, the use of effective communication skills and the use of successful conflict management skills.

Healthy Marriage Matters

Research suggests that children who grow up in healthy married, two-parent families do better on a host of outcomes than those who do not. Further, many social problems affecting children, families, and communities could be prevented if more children grew up in healthy, married families.

Examples of social science findings include:

• Married couples seem to build more wealth, on average, than singles or cohabiting couples, thus decreasing the likelihood that their children will grow up in poverty.
• Children who live in a two-parent, married household enjoy better physical health, on average, than children in non-married households.
• Healthy marriages reduce the risk of adults and children either perpetrating, or being victimized by, crime.Benefits of Healthy Marriages

For Children and Youth

Researchers have found many benefits for children and youth who are raised by parents in healthy marriages, compared to unhealthy marriages, including the following:

1. More likely to attend college
2. Demonstrate less behavioral problems in school
3. Less likely to be a victim of physical or sexual abuse
4. Less likely to abuse drugs or alcohol
5. Less likely to commit delinquent behaviors
6. More likely to succeed academically
7. Physically healthier
8. Emotionally healthier
9. Less likely to attempt or commit suicide
10. Decreases their chances of divorcing when they get married
11. Less likely to become pregnant as a teenager, or impregnate someone.
12. Less likely to be sexually active as teenagers
13. Less likely to contract STD’s
14. Less likely to be raised in poverty

For Women

Researchers have found many benefits for women who are in healthy marriages, compared to unhealthy marriages, including the following:

1. More satisfying relationship
2. Emotionally healthier
3. Wealthier
4. Less likely to be victims of domestic violence, sexual assault, or other violent crimes
5. Less likely to attempt or commit suicide
6. Decrease risk of drug and alcohol abuse
7. Less likely to contract STD’s
8. Less likely to remain or end up in poverty
9. Have better relationships with their children
10. Physically healthier

For Men

Researchers have found many benefits for men who are in healthy marriages, compared to unhealthy marriages, including the following:

1. Physically healthier
2. Wealthier
3. Increase in the stability of employment
4. Higher wages
5. Emotionally healthier
6. Decrease risk of drug and alcohol abuse
7. Have better relationships with their children
8. Less likely to commit violent crimes
9. Less likely to contract STD’s
10. Less likely to attempt or commit suicide

For Communities

Researchers have found many benefits for communities when they have a higher percentage of couples in healthy marriages, compared to unhealthy marriages, including the following:

1. Higher rates of physically healthy citizens
2. Higher rates of emotionally healthy citizens
3. Higher rates of educated citizens
4. Lower domestic violence rates
5. Lower crime statistics
6. Lower teen age pregnancy rates
7. Lower rates of juvenile delinquency
8. Higher rates of home ownership
9. Lower rates of migration
10. Higher property values
11. Decreased need for social services

Marital Status and Health: United States, 1999–2002

A report from the Centers for Disease Control and Prevention suggests that married adults are healthier than divorced, widowed or never married adults.
The report, “Marital Status and Health: United States, 1999-2002,” was based on interviews with 127,545 adults aged 18 and over as part of the National Health Interview Survey, conducted by CDC’s National Center for Health Statistics. The study looked at health status and limitations, health conditions, health related behaviors according to marital status and also by age, race/ethnicity and socioeconomic factors such as education and poverty status.

Among the findings in the report:

• Nearly 60% of adults are married, 10.4% are separated or divorced, 6.6% are widowed, 19% are never married and 5.7% are living with a partner. Marital status varies greatly among race/ethnic groups: approximately 61 percent of white adults, 58 percent of Hispanic adults, and 38 percent of black adults are married, according to the survey.
• Married adults are less likely than other adults to be in fair or poor health, and are less likely to suffer from health conditions such as headaches and serious psychological distress.
• Married adults are less likely be limited in various activities, including work and other activities of daily living.
• Married adults are less likely to smoke, drink heavily or be physically inactive. However, married men are more likely to be overweight or obese than other men.
• Adults who live in cohabiting relationships are more likely to have health problems than married adults and more closely resemble divorced and separated adults.
• The association between marital status and health is most striking in the youngest age group although it persists throughout the age groups studied.

While the results show that married adults are generally in better health than unmarried adults, the reasons for better health status among married adults cannot be determined with cross-sectional data collected in the National Health Interview Survey.

The Effects of Marriage on Health

Understanding the Marriage-Health Connection

The relationship between marriage and health is complex. Marital status can both affect health outcomes and be affected by them. Healthier people may have a better chance of marrying and staying married because they may be viewed as more desirable marriage partners based on their physical attractiveness, earnings potential, mental well-being, degree of self-sufficiency, or likely longevity. Social scientists describe this pattern as the selection of healthy people into marriage. If this is the only reason for the correlation between marriage and health, then marriage is not causing better health. Instead, the observed health differences between married and unmarried people are the result of healthier people being more likely to marry.

Alternatively, there may be a true causal link between marriage and better health. Marriage could improve health outcomes in a variety of ways. It may result in two incomes, as well as economies of scale, improving economic well-being.

Having more income could, in turn, improve health outcomes by enhancing access to health care or lowering stress. In addition, a spouse may play an important role in monitoring and encouraging healthy behaviors (such as good eating habits and regular exercise), as well as in discouraging unhealthy ones (such as smoking or heavy drinking). Marriage may also provide an emotionally fulfilling, intimate relationship, satisfying the need for social connection, which could have implications for both physical and mental health. Most researchers conclude that the association between marriage and health represents a combination of the selection of healthier people into marriage and true health benefits from marriage.

Measuring the Effects of Marriage

Because marriage is likely to be both a cause and a consequence of health outcomes, research must disentangle the influence of selection from the true causal influence of marriage. Distinguishing between these two factors requires careful analysis and advanced statistical methods that have been absent from many studies.

The studies providing the strongest evidence use longitudinal data and examine the association between changes in health outcomes and transitions into and out of marriage. Studies of this type provide more convincing evidence of a causal relationship between marriage and health because sample members serve as their own control group, and the effect of marriage is measured by comparing their outcomes before and after marriage. This method avoids comparing two groups that may have different background characteristics in particular, people who marry and people who do not which may lead to misleading and inaccurate results.

Some health outcomes are not well suited for this type of analysis, however. For example, many physical health outcomes cannot be examined in this way, because changes can unfold over a long time and may not be apparent immediately after a marital transition.

Effects on Health Behaviors

Marriage may influence health through its effect on behaviors such as alcohol consumption, drug use, cigarette smoking, diet, and exercise. Recent research suggests that marriage has significant effects on the health behaviors of both men and women, but the pattern is mixed marriage is associated with healthier behaviors in some cases and less healthy behaviors in others. Studies consistently indicate that marriage reduces heavy drinking and overall alcohol consumption, and that effects are similar for young men and young women, and for both African Americans and whites. Although the research is less extensive, marriage is also associated with reduced marijuana use for young men, but less so for women. Less is known about the effects of marriage on the substance use of older adults. Studies of marriage and smoking reveal no consistent pattern of results, suggesting that marriage may have little or no influence on this behavior.

In contrast to studies of alcohol and drug use, studies of the effect of marriage on weight and physical activity suggest that marriage may have negative effects on healthy behaviors and may encourage a more sedentary lifestyle. Several rigorous studies find that marriage leads to modest weight increases for both men and women; typically averaging less than five pounds. The research on the effects of marriage on physical activity is less conclusive because it is not based on longitudinal analysis and does not fully adjust for differences between those who marry and those who do not. The evidence that is available suggests marriage may lead to reductions in physical activity, particularly for men.

For certain health behaviors in particular, substance use among younger adults and weight gain among all adults the influence of marriage has been well studied and is well understood. For other behaviors, less is known and additional research is needed before stronger conclusions can be drawn.

Effects on Health Care Access, Use, and Costs

Marriage may influence physical health through its effects on health care access and use. Studies of the link between marriage and health insurance suggest that by offering access to coverage through a spouse’s policy marriage increases the likelihood of having insurance and reduces the likelihood of becoming uninsured after a job loss or other major life event. Limited evidence also suggests that marriage may increase the use of preventive care such as cancer screenings.

Because of its effects on health care use, marriage is also associated with lower health care costs among older adults. For example, studies show that, because marriage reduces the risk of nursing home admission, marriage may also lead to reduced nursing home costs. The effect of marriage in shortening hospital stays may also lead to reductions in health care costs. Research indicates that the effect of marriage on health care costs exists independent of the effect of marriage on physical health. Specifically, many married people rely on their spouses for informal care, and thus require fewer long hospital stays and nursing home admissions, resulting in lower health care costs even if married and unmarried older adults are equally likely to get sick. These studies find that wives are especially likely to provide informal care for their husbands at home, so the effect of marriage on health care costs may be larger for men.

Effects on Mental Health

Marriage may affect many aspects of mental health. The most recent rigorous research suggests that marriage reduces depressive symptoms for both men and women. In particular, these studies find that getting married decreases depressive symptoms, while getting divorced increases them. Research has also documented that increases in depressive symptoms after divorce are long-lasting and that the prevalence of these symptoms remains elevated years after the marital breakup. In addition, studies comparing the mental health of stably married adults to those who remain unmarried find that those who are stably married have fewer depressive symptoms (and smaller increases in these symptoms as they grow older), even after controlling for baseline mental health.

Effects on Physical Health and Longevity

Many studies have documented that people who marry live longer and enjoy better physical health than those who do not marry. However, methodological issues require caution in interpreting this pattern, because most of the research in this area relies on descriptive methods that do not adequately control for the possible selection of healthier people into marriage. Although central to the overall assessment of the link between marriage and health, rigorous research evidence concerning the effect of marriage on specific physical health outcomes is limited, and few solid conclusions can be drawn.

The rigorous research currently available provides limited evidence of an effect of marriage on physical health. Recent research finds a significant positive effect of marriage on how men rate their overall physical health status; however, it finds no such effect for women. Researchers find a positive effect on women’s physical health, as measured by the prevalence of specific health conditions and illnesses. However, no recent rigorous studies based on U.S. samples have examined whether a similar marriage effect on the frequency of health conditions or illnesses exists among men. Similarly, little evidence exists on the links between marriage and specific health conditions or diseases. One exception is a recent study that suggests a possible link between marriage and the risk of cardiovascular disease for women; however, the study finds no such effect for men. Overall, the existing research evidence on the links between marriage and physical health is limited to a narrow range of health measures and does not offer a complete picture of the influence of marriage on physical health.

Many studies have pointed to a strong relationship between marriage and longevity, but this research also has limitations. In particular, these studies are typically limited to simple descriptive comparisons of married and unmarried adults that do not adequately distinguish the effect of marriage from the possible effects of healthier people selecting into marriage. As noted, the most reliable studies of links between marriage and health examine measures directly before and after marital transitions. However, because longevity is determined only at the end of life, it is not possible to observe how a marital transition changes longevity.

Intergenerational Health Effects

An emerging literature on the possible intergenerational health effects of marriage suggests that marriage also has potential long-term consequences for the physical health of a couple’s children. In particular, studies show that growing up with married parents is associated with better physical health in adulthood and increased longevity. Research suggests that such intergenerational health effects are especially strong for men and operate equally for African American and white men. There is less evidence examining possible differences in this relationship for African American and white women.

There are many possible reasons why parental marital status may have long-term health consequences for children. However, existing research provides limited evidence on the pathways by which childhood family structure affects adult physical health and longevity. Several studies suggest that the effects work mostly through the role of childhood family structure in shaping children’s future socioeconomic attainment, and through adult health risk behaviors, such as smoking and heavy drinking. On average, children raised in two-parent families obtain more education and exhibit healthier adult behaviors than children from other types of families. These differences, in turn, have consequences for adult health and longevity.

Research on intergenerational health effects has focused on trends for people born in the late 19th and early 20th centuries, a period when patterns of marriage, divorce, and single parenthood were much different from today. It is possible that the apparent benefits of marriage for children’s health have weakened as single parenthood and divorce have become more common and less stigmatizing. In addition, much of the research is limited to data for small nonrepresentative samples. The available nationally representative evidence is based on data sets that began tracking sample members as adults, which limits the ability to control for differences in the background characteristics of those who grew up in a two-parent family and those who did not.