Mechanisms explaining the negative effects of parental divorce on children's attainment have long been conjectured and assessed. Yet few studies of parental divorce have carefully attended to the assumptions and methods necessary to estimate causal mediation effects. Applying a causal framework to linked U.S. panel data, we assess the degree to which parental divorce limits children's education among whites and nonwhites and whether observed lower levels of educational attainment are explained by postdivorce family conditions and children's skills. Our analyses yield three key findings. First, the negative effect of divorce on educational attainment, particularly college, is substantial for white children; by contrast, divorce does not lower the educational attainment of nonwhite children. Second, declines in family income explain as much as one- to two-thirds of the negative effect of parental divorce on white children's education. Family instability also helps explain the effect, particularly when divorce occurs in early childhood. Children's psychosocial skills explain about one-fifth of the effect, whereas children's cognitive skills play a minimal role. Third, among nonwhites, the minimal total effect on education is explained by the offsetting influence of postdivorce declines in family income and stability alongside increases in children's psychosocial and cognitive skills.

Background

Fall-related injuries are a well-described cause of morbidity and mortality in the community-dwelling elderly population, but have not been well described in patients with cancer. Cancer treatment with chemotherapy can result in many unwanted side effects, including peripheral neuropathy if the drugs are potentially neurotoxic. Peripheral neuropathy and other side effects of chemotherapy may lead to an increased risk of fall-related injuries.

Methods

We conducted a retrospective cohort analysis using the records of 65,311 patients with breast, colon, lung, or prostate cancer treated with chemotherapy in the SEER-Medicare database from 1994 to 2007. The primary outcome was any fall-related injury defined as a traumatic fracture, dislocation, or head injury within 12 months of the first dose of chemotherapy. The sample population was divided into 3 cohorts based on whether they most frequently received a neurotoxic doublet, single agent, or a non-neurotoxic chemotherapy. Cox proportional-hazards analyses were adjusted for baseline characteristics to determine the risk of fall-related injuries among the 3 cohorts.

Results

The rate of fall-related injuries for patients receiving a doublet of neurotoxic chemotherapy (9.15 per 1000 person-months) was significantly higher than for those receiving a single neurotoxic agent (7.76 per 1000 person-months) or a non-neurotoxic agent (5.19 per 1000 person-months). Based on the Cox proportional-hazards model risk of fall-related injuries was highest for the cohort receiving a neurotoxic doublet after the model was adjusted for baseline characteristics.

Conclusions

Among elderly patients with cancer, use of neurotoxic chemotherapy is associated with an increased risk of fall-related injuries.

Children whose parents divorce tend to have worse educational outcomes than children whose parents stay married. However, not all children respond identically to their parents divorcing. We focus on how the impact of parental divorce on childrens education varies by how likely or unlikely divorce was for those parents. We find a significant negative effect of parental divorce on educational attainment, particularly college attendance and completion, among children whose parents were unlikely to divorce. Families expecting marital stability, unprepared for disruption, may experience considerable adjustment difficulties when divorce occurs, leading to negative outcomes for children. By contrast, we find no effect of parental divorce among children whose parents were likely to divorce. Children of high-risk marriages, who face many social disadvantages over childhood irrespective of parental marital status, may anticipate or otherwise accommodate to the dissolution of their parents marriage. Our results suggest that family disruption does not uniformly disrupt childrens attainment.

Children whose parents divorce tend to have worse educational outcomes than children whose parents stay married. However, not all children respond identically to their parents divorcing. We focus on how the impact of parental divorce on children's education varies by how likely or unlikely divorce was for those parents. We find a significant negative effect of parental divorce on educational attainment, particularly college attendance and completion, among children whose parents were unlikely to divorce. Families expecting marital stability, unprepared for disruption, may experience considerable adjustment difficulties when divorce occurs, leading to negative outcomes for children. By contrast, we find no effect of parental divorce among children whose parents were likely to divorce. Children of high-risk marriages, who face many social disadvantages over childhood irrespective of parental marital status, may anticipate or otherwise accommodate to the dissolution of their parents' marriage. Our results suggest that family disruption does not uniformly disrupt children's attainment.