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Marital Status and Health Outcomes in a Developing Country

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Marital Status and Health Outcomes in a Developing Country MARITAL STATUS AND HEALTH OUTCOMES IN A DEVELOPING COUNTRY: EXPLORING THE CONTEXTUAL EFFECTS OF MARRIAGE, GENDER, CHILDREN, AND LINEAL TIES ON SUBJECTIVE HEALTH IN GHANA A Dissertation Presented to The Graduate Faculty of The University of Akron In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Enoch Lamptey August, 2017 MARITAL STATUS AND HEALTH OUTCOMES IN A DEVELOPING COUNTRY: EXPLORING THE CONTEXTUAL EFFECTS OF MARRIAGE, GENDER, CHILDREN, AND LINEAL TIES ON SUBJECTIVE HEALTH IN GHAN Enoch Lamptey Dissertation Approved: Accepted: ________________________________ ____________________________________ Advisor Interim Department Chair Dr. Baffour K. Takyi Dr. William T. Lyons ________________________________ ____________________________________ Committee Member Interim Dean of the College Dr. Juan Xi Dr. John Green ________________________________ ____________________________________ Committee Member Interim Dean of the Graduate School Dr. Clare Stacey Dr. Chand Midha ________________________________ ____________________________________ Committee Member Date Dr. Adrianne M. Frech ________________________________ Committee Member Dr. Jun Ye ii ABSTRACT A growing body of literature on marriage and health suggest that marriage is beneficial to health-—physical, psychological, behavioral, and longevity. Additionally, there are inconsistencies in the existing literature concerning the effect of gender and children on the association between marital status and health outcomes. However, the vast majority of these studies rely on data from Western developed countries such as United States of America, Canada, and other developed countries; and they leave open questions with regards to whether the hypothesized relationship between marriage and positive health outcomes are equally applicable or generalizable to other countries, especially less developed countries. The purpose of this dissertation was to contribute to the existing cross-cultural literature on marriage and health. This study also focused on how culturally specific issues such as communalistic cultural values and practices, which are pervasive in the Ghanaian’s society, may improve the wellbeing (health) of never- married Ghanaians. Using theoretically driven models and nationally representative data from the 2011 Ghana World Value Survey (n = 1552), this study examined marriage and family processes in Ghana, and how they are associated with health. I examined whether there was variation in health among currently, previous, and never married people in Ghana, and how sociocultural practices such as the significant attachment to children influence the association between marital status and health. iii Findings from the analyses show that in general and contrast to what has been reported in the Western literature, in Ghana, I did not find that the married have better health than their never-married counterparts. The results show that compared to the currently and never married, formerly married Ghanaians reported the worst health. Gender did not moderate the relationship between marital status and health. The presence of children rather than diminish the health of the married increased their health. Also, I found that among patrilineal ethnic groups in Ghana, married persons experienced better health relative to their unmarried counterparts. On the contrary, among matrilineal ethnic groups in Ghana, there is no variation in self-rated health among the currently, previous, and the never-married. I conclude with some limitations and policy implications of the findings. iv ACKNOWLEDGEMENTS There are many people I am must thank for their support, help, and encouragement during the completion of this dissertation. First, I would like to express my sincere gratitude to my advisor and chair of my dissertation committee, Dr. Baffour K Takyi, for his guidance and support throughout my graduate career. I am so grateful to have the opportunity to work with such a wonderful scholar, advisor, and friend. I would like to thank Dr. Juan Xi for her support, patience, and encouragement throughout the dissertation process and my graduate career as well. Dr. Xi was very instrumental both in my personal and graduate life and nurtured me to be a studious fellow and a great scholar. I appreciate the constant constructive criticisms from her and grateful for her giving me the opportunity to have my first publication as a graduate student. I would also like to give a special thanks to Dr. Clare Stacey for her profound guidance and providing me with all the necessary tools to excel in my graduate and professional career. I am grateful for her kindness to my family and me. I would like to acknowledge my other committee members. Thanks to Dr. Adrianne Frech and Dr. Jun Ye for their valuable contribution throughout the dissertation process. I also want to recognize individuals who took time from their busy schedules to review my dissertation: Dr. Chris Opoku-Agyeman, Department of Public Administration and Urban Studies-The University of Akron, and my colleague, Rachael Pesta, Department of Sociology, the University of Akron. I would like to thank the following members of the Sociology Department for their guidance, friendship, and support during v my graduate years at The University of Akron: Dr. John Zipp, Dr. Matthew Lee, Dr. Stacey Nofziger, Dr. Jodi-Ross Hendersen, Dr. Kathryn Feltey, and Dr. Manacy Pai. My friends in the Sociology Department deserve special thanks, particularly Nusrat Islam, Corey Stevens, Rania Issa, Kristin Santos, Dr. Will LeSeur, and Dr. Peter Barr (who are no longer at the department). Your friendship, support, and many emails of encouragement have made my years at the department less stressful. It has been a wonderful experience working and learning with you. To you Dr. LeSeur, thanks for your professional and personal support. I value your friendship and cannot thank you enough for your immense guidance, words of encouragements, and learning statistical methods from you. In addition to the above-mentioned names, I also wish to acknowledge the moral support of the following persons: Emmanuel Boadi Atta, Daniel Nana Yaw Amponsah, Belinda Lamptey, Willhemina Lamptey, George Lamptey, Leo Lamptey, and Naa Koshie Lamptey (Ghana). Thanks for being there for me over the years. I appreciate your support, motivation, and advice. You have made this process so much less stressful. God richly bless you all. I would like to give a special thanks to my wife, Angela Lamptey, and my two lovely children, Leron and Darryl Lamptey. To you Angela, I am extremely grateful for your support, love, prayers, and encouragement throughout the dissertation process as well as my graduate years in the U.S. You are indeed a wonderful wife and I thank God for your life. I would not have made it without your support, especially taking care of our two wonderful kids when I am away from the family. Thank you, my love. vi DEDICATION I will bless the LORD at all times; His praise shall continually be in my mouth (Psalm 34:1). First, I want to dedicate all my accomplishments to God for giving me life, knowledge, and supporting my family and me over the years. Second, I dedicate this dissertation to my wife, Angela Lamptey, children (Leron and Darryl Lamptey), my mum, Beatrice Afanu Lamptey, and my late dad, Bismark Lamptey. Daddy, although you are no longer with us today, I know you are proud of me, for what I have accomplished since it has always been your dream to see me succeed academically, and in life. Third, to my siblings (Belinda, Willhemina, and George), Dr. Baffour Takyi, Dr. Juan Xi, and Dr. Clare Stacey for their tremendous support, guidance, dedication, and mentoring towards my successes and accomplishments. Thank you very much. vii TABLE OF CONTENTS Page LIST OF TABLES ............................................................................................................. xi LIST OF FIGURES .......................................................................................................... xii CHAPTER I. THE RESEARCH CONTEXT: MARRIAGE AND HEALTH .................................1 1.1 Introduction ....................................................................................................1 1.2 The Present Study: Problem Statement and Limited Research .....................5 1.3 Significance of the Study .............................................................................13 1.4 Research Objectives .....................................................................................15 1.5 Research Questions ......................................................................................15 1.6 Organization of the Study ............................................................................16 II. LITERATURE REVIEW .........................................................................................18 2.1 The Theoretical Context on the Links Between Marriage and Health ........18 2.2 Why Marriage Is Associated with Health ....................................................19 2.3 The Crisis/Stress Theory ..............................................................................26 2.4 The Social Selection Theory ........................................................................27 2.5 Marriage and Mental Health ........................................................................29 2.6 Marriage and Physical Health ......................................................................33 2.7 Marriage and Health Behaviors
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