An Exploration of the Influence of Household Poverty Spells on Mortality Risk

Household poverty is dynamic and characterized in terms of spells. Exposure to poverty accumulates through the recurrence and persistence of spells, leading to divergent family adaptive strategies that contribute to mortality risk. The data set used in this study is longitudinal and contains socioeconomic and demographic data of a nationally representative sample. The findings are (a) poverty significantly increases mortality risk, controlling for age, gender, and race; (b) the first spell is especially potent, and mortality risk declines rapidly during subsequent spells; and (c) both direction and strength of these estimates are robust to marital status, but power diminishes significantly net of education and employment. Key Words: family adaptive strategies, mortality, [overty spell. As current research has described, the conceptualization of socioeconomic status as it relates to mortality is not well understood (Krieger, Williams, & Moss, 1997). One of the gaps in our understanding is the impact of change over time, as opposed to the effects of a condition or situation at a single point in time. A comparison of poverty status and poverty spells makes this distinction clear. The state of being without adequate food, clothing, shelter, childcare, health care, and transportation defines poverty status. In research on mortality, an indicator of whether an individual is poor frequently is used to articulate poverty status and estimate its association with the risk of mortality (see Hahn et al., 1996; Lynch, Kaplan, & Shema 1997; Smith & Waitzman, 1994; Zick & Smith, 1991). Nonetheless, Naifeh (1998) estimated an exit rate of 24% from poverty in 1993 and 1994, whereas Stevens (1994) found that among persons who have escaped poverty for 1 year, 27% fall into a second spell. These statistics indicate extensive movement in and out of poverty, which can be captured only through a temporal measure such as a poverty spell. The transitions in and out of poverty define a spell, although it can be portrayed in terms of a beginning, an interval of time, and an end. In this study, a spell is a measure of exposure, signifying a period of time lived in disadvantageous circumstances. Most poverty spells, 75%, last for 1 year or less (Naifeh, 1998), connoting a fairly brief period of exposure. Other periods of exposure are prolonged, and approximately 13% of spells in the early 1990s lasted for more than 2 years (Naifeh; Shea, 1995). Exposure to poverty accumulates through the recurrence and persistence of spells, and variation in cumulative exposure consequently may differentiate the risks of mortality. To form a link between poverty exposure and mortality risk, I concentrated on family adaptive strategies. Families find their options and resources structured by economic misfortune such that it determines their ability to adapt to the present and manage their lives in the future (Moen, Kain, & Elder 1983). Poverty dynamics determine options and resources and therefore can motivate families to develop practices and ways to deal with their circumstances. These strategies will vary, depending on exposure to poverty. In combination, poverty spells and family adaptive strategies may ultimately contribute to mortality risk. BACKGROUND A handful of recent studies consider the association between income and poverty dynamics and the risk of mortality. The general finding concerning the length of time during which a low household income remains unchanged is that duration is positively associated with the chances of dying. Combining both level of household income and period of time, McDonough, Duncan, Williams, & House (1997) found an income of less than $20,000 that persists for 4 to 5 years is associated with a 3.5 times greater likelihood of mortality. This likelihood declines to 2.5 if the level of household income is below $20,000 for a temporary period (i.e., 2 to 3 years; McDonough et al. …