The children of different-sex married couples appear to be advantaged on a range of outcomes relative to the children of different-sex cohabiting couples. Despite the legalization of same-sex marriage in the United States, whether and how this general pattern extends to the children of same-sex married and cohabiting couples is unknown. This study examines this question with nationally representative data from the 2004–2013 pooled National Health Interview Survey (NHIS). Results reveal that children in cohabiting households have poorer health outcomes than children in married households regardless of the sex composition of their parents. Children in same-sex and different-sex married households are relatively similar to each other on health outcomes, as are children in same-sex and different-sex cohabiting households. These patterns are not fully explained by socioeconomic differences among the four different types of families. This evidence can inform general debates about family structure and child health as well as policy interventions aiming to reduce child health disparities.
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Albrecht, C., & Teachman, J. D. (2003). Childhood living arrangements and the risk of premarital intercourse. Journal of Family Issues, 24, 867–894.
Amato, P. R. (2005). The impact of family formation change on the cognitive, social, and emotional well-being of the next generation. Marriage and Child Wellbeing, 15, 75–96.
Artis, J. E. (2007). Maternal cohabitation and child well-being among kindergarten children. Journal of Marriage and Family, 69, 222–236.
Ash, M. A., & Badgett, M. V. L. (2006). Separate and unequal: The effect of unequal access to employment-based health insurance on same-sex and unmarried different-sex couples. Contemporary Economic Policy, 24, 582–599.
Badgett, M. V. L. (2001). Money, myths, and change: The socioeconomic lives of lesbians and gay men. New York: New York University Press.
Badgett, M. V. L., Gates, G. J., & Maisel, N. C. (2008). Registered domestic partnerships among gay men and lesbians: The role of socioeconomic factors. Review of Socioeconomics of the Household, 6, 327–346.
Bass, L. E., & Warehime, N. (2011). Family structure and child health outcomes in the United States. Sociological Inquiry, 81, 527–548.
Bergstrom, T. (1997). A survey of theories of the family. In M. R. Rosenzweig & O. Stark (Eds.), Handbook of population and family socioeconomics (pp. 21–79). Amsterdam, The Netherlands: Elsevier.
Black, D., Gates, G., Sanders, S., & Taylor, L. (2000). Demographics of the gay and lesbian population in the United States: Evidence from available systemic data sources. Demography, 37, 139–154.
Black, D., Gates, G., Sanders, S., & Taylor, L. (2007a). The measurement of same-sex unmarried partner couples in the 2000 U.S. Census (Working Paper Series, No. CCPR-023-07). Los Angeles: California Center for Population Research.
Black, D. A., Sanders, S. G., & Taylor, L. J. (2007b). The economics of lesbian and gay families. Journal of Socioeconomic Perspectives, 21, 53–70.
Bradley, R. H., & Corwyn, R. F. (2002). Socioeconomic status and child development. Annual Review of Psychology, 53, 371–399.
Brion, M.-J., Victora, C., Matjasevich, A., Horta, B., Anselmi, L., Steer, C., . . . Davey Smith, G. (2010). Maternal smoking and child psychological problems: Disentangling causal and non-causal effects. Pediatrics, 126, e57–e65. doi:10.1542/peds.2009-2754
Brown, S. L. (2006). Family structure transitions and adolescent well-being. Demography, 43, 447–461.
Brown, S. L., & Manning, W. D. (2009). Family boundary ambiguity and the measurement of family structure: The significance of cohabitation. Demography, 46, 85–101.
Burgoyne, S. (2012). Demographic profile of same-sex parents (NCFMR Family Profiles Report No. FP-12-15). Bowling Green, OH: National Center for Family and Marriage Research. Retrieved from http://ncfmr.bgsu.edu/pdf/file115683.pdf
Carlson, M. J. (2006). Family structure, father involvement, and adolescent behavioral outcomes. Journal of Marriage and Family, 68, 137–154.
Cavanagh, S. E., & Huston, A. C. (2008). The timing of family instability and children’s social development. Journal of Marriage and Family, 70, 1258–1270.
Cheng, S., & Powell, B. (2015). Measurement, methods, and divergent patterns: Reassessing the effects of same-sex parents. Social Science Research, 52, 615–626.
Cherlin, A. J. (2004). The deinstitutionalization of American marriage. Journal of Marriage and Family, 66, 848–861.
Cooksey, E. C., Menaghan, E. G., & Jekielek, S. M. (1997). Life-course effects of work and family circumstances on children. Social Forces, 76, 637–665.
Crosnoe, R., & Wildsmith, E. (2011). Nonmarital fertility, family structure, and the early school achievement of young children from different race/ethnic and immigration groups. Applied Developmental Science, 15, 156–170.
Deleire, T., & Kalil, A. (2002). Good things come in threes: Single-parent multigenerational family structure and adolescent adjustment. Demography, 39, 393–413.
Denney, J. T., Gorman, B. K., & Barrera, C. B. (2013). Families, resources, and adult health: Where do sexual minorities fit? Journal of Health and Social Behavior, 54, 46–63.
Duncan, G. J., Brooks-Gunn, J., & Klebanov, P. K. (1994). Economic deprivation and early childhood development. Child Development, 65, 296–318.
Dunifon, R. E., & Kowaleski-Jones, L. (2002). Who’s in the house? Race differences in cohabitation, single-parenthood and child development. Child Development, 73, 1249–1264.
Eggebeen, D. J. (2012). What can we learn from studies of children raised by gay or lesbian parents? Social Science Research, 41, 775–778.
Eiser, C., & Morse, R. (2001). Can parents rate their child’s health-related quality of life? Results of a systematic review. Quality of Life Research, 10, 347–357.
Farr, R. H., Forssell, S. L., & Patterson, C. J. (2010). Parenting and child development in adoptive families: Does parental sexual orientation matter? Applied Developmental Science, 14, 164–178.
Gartrell, N., & Bos, H. (2010). U.S. National Longitudinal Lesbian Family Study: Psychological adjustment of 17-year-old adolescents. Pediatrics, 126, 28–36.
Gates, G. J. (2013). LGBT parenting in the United States (Research brief). Los Angeles, CA: Williams Institute, UCLA School of Law. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-Parenting.pdf
Gates, G. J., et al. (2012). Letter to the editors and advisory editors of Social Science Research. Social Science Research, 41, 1350–1351.
Gonzales, G., & Blewett, L. A. (2013). Disparities in health insurance among children with same-sex parents. Pediatrics, 132, 703–711.
Hatzenbuehler, M. L., McLaughlin, K. A., Keyes, K. M., & Hasin, D. S. (2010). The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: A prospective study. American Journal of Public Health, 100, 452–459.
Heck, J. E., Sell, R. L., & Gorin, S. S. (2006). Health care access among individuals involved in same-sex relationships. American Journal of Public Health, 96, 1111–1118.
Heck, K. E., & Parker, J. D. (2002). Family structure, socioeconomic status, and access to health care for children. Health Services Research, 37, 173–186.
Hequembourg, A. L. (2004). Unscripted motherhood: Lesbian mothers negotiating incompletely institutionalized family relationships. Journal of Social and Personal Relationships, 21, 739–762.
Herek, G. M. (2006). Legal recognition of same-sex relationships in the United States: A social science perspective. American Psychologist, 61, 607–621.
Lamb, M. E. (2012). Mothers, fathers, families, and circumstances: Factors affecting children’s adjustment. Applied Developmental Science, 16, 98–111.
Langton, C. E., & Berger, L. M. (2011). Family structure and adolescent physical health, behavior, and emotional well-being. Social Service Review, 85, 323–357.
Lansford, J. E., Ceballo, R., Abbey, A., & Stewart, A. (2001). Does family structure matter? A comparison of adoptive, two-parent biological, single-mother, stepfather, and stepmother households. Journal of Marriage and Family, 63, 840–851.
Lau, C. Q. (2012). The stability of same-sex cohabitation, different-sex cohabitation, and marriage. Journal of Marriage and Family, 74, 973–988.
Link, B. G., & Phelan, J. C. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35, 80–94.
Liu, H., Reczek, C., & Brown, D. (2013). Same-sex cohabitors and health: The role of gender, race-ethnicity, and socioeconomic status. Journal of Health and Social Behavior, 54, 25–45.
Lofquist, D. (2011). Same-sex couple households (American Community Survey Briefs No. 10–03). Washington, DC: U.S. Census Bureau. Retrieved from http://www.census.gov/prod/2011/pubs/acsbr10-03.pdf
Lofquist, D. (2012, May). Same-sex couples’ consistency in reports of martial status. Paper presented at the annual meeting of the Population Association of America, San Francisco, CA. Retrieved http://www.census.gov/hhes/samesex/files/Lofquist.PAA.paper.pdf
Manning, W. D. (2004). Children and the stability of cohabiting couples. Journal of Marriage and Family, 66, 674–689.
Manning, W. D., & Brown, S. L. (2006). Children’s economic well-being in married and cohabiting parent families. Journal of Marriage and Family, 68, 345–362.
Manning, W. D., Fettro, M. N., & Lamidi, E. (2014). Child well-being in same-sex parent families: Review of research prepared for American Sociological Association amicus brief. Population Research and Policy Review, 33, 485–502.
Manning, W. D., & Lamb, K. A. (2003). Adolescent well-being in cohabiting, married, and single-parent families. Journal of Marriage and Family, 65, 876–893.
Manning, W. D., & Lichter, D. T. (1996). Parental cohabitation and children’s economic well-being. Journal of Marriage and the Family, 58, 998–1010.
Manning, W. D., Smock, P. J., & Majumdar, D. (2004). The stability of cohabiting and marital unions for children. Population Research and Policy Review, 23, 135–159.
McLanahan, S. S. (2004). Diverging destinies: How children fare under the second demographic transition. Demography, 41, 607–627.
McLanahan, S., & Percheski, C. (2008). Family structure and the reproduction of inequalities. Annual Review of Sociology, 34, 257–276.
Meezan, W., & Rauch, J. (2005). Gay marriage, same-sex parenting, and America’s children. Future of Children, 15(2), 97–115.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.
Minnesota Population Center and State Health Access Data Assistance Center (2014). Integrated Health Interview Series: Version 5.0 [Data set]. Minneapolis: University of Minnesota.
Moore, M. R., & Stambolis-Ruhstorfer, M. (2013). LGBT sexuality and families at the start of the twenty-first century. Annual Review of Sociology, 39, 491–507.
Nock, S. L. (1995). A comparison of marriages and cohabiting relationships. Journal of Family Issues, 16, 53–76.
O’Connell, M., Lofquist, D., Simmons, T., & Lugalla, T. (2010, April). New estimates of same-sex couple households from the American Community Survey. Paper presented at the annual meeting of the Population Association of America, Dallas, TX. Retrieved from http://www.census.gov/hhes/samesex/files/SS_new-estimates.pdf
Potter, D. (2012). Same-sex parent families and children’s academic achievement. Journal of Marriage and Family, 74, 556–571.
Prickett, K. C., Martin-Storey, A., & Crosnoe, R. (2015). A research note on time with children in different- and same-sex two-parent families. Demography, 52, 905–918.
Reczek, C., Elliot, S., & Umberson, D. (2009). Commitment without marriage: Union formation among long-term same-sex couples. Journal of Family Issues, 30, 738–756.
Reczek, C., Liu, H., & Spiker, R. (2014). A population-based study of alcohol use in same-sex and different-sex unions. Journal of Marriage and Family, 76, 557–579.
Regnerus, M. (2012). How different are the adult children of parents who have same-sex relationships? Findings from the New Family Structures Study. Social Science Research, 41, 752–770.
Rosenfeld, M. J. (2010). Nontraditional families and childhood progress through school. Demography, 47, 755–775.
Rosenfeld, M. J. (2014). Couple longevity in the era of same-sex marriage in the United States. Journal of Marriage and Family, 76, 905–918.
Shrivastava, A., Murrin, C., & Kelleher, C. C. (2014). Preschoolers’ parent-rated health disparities are strongly associated with matters of adiposity in the Lifeways Cohort Study Children. British Medical Journal Open, 4, e005328. doi:10.1136/bmjopen-2014-005328.
Siegel, B. S., Perrin, E. C., & the Committee on Psychosocial Aspects of Child and Family Health (2013). Promoting the well-being of children whose parents are gay or lesbian. Pediatrics, 131, 827–830.
Smock, P. J. (2000). Cohabitation in the United States: An appraisal of research themes, findings, and implications. Annual Review of Sociology, 26, 1–20.
Stein, R. E. K. (2011). A measured approach to child health. Academic Pediatrics, 11, 240–246.
Stein, R. E. K., Siegel, M. J., & Bauman, L. J. (2010). Double jeopardy: What social risk adds to biomedical risk in understanding child health and child healthcare utilization. Academic Pediatrics, 10, 165–171.
Sun, Y., & Li, Y. (2004). Children’s well-being during parents’ marital disruption process: A pooled time-series analysis. Journal of Marriage and Family, 64, 472–488.
Videon, T. M. (2002). The effects of parent-adolescent relationships and parental separation on adolescent well-being. Journal of Marriage and Family, 64, 489–503.
Wainright, J. L., & Patterson, C. J. (2006). Delinquency, victimization, and substance use among adolescents with female same-sex parents. Journal of Family Psychology, 20, 526–530.
Wainright, J. L., Russell, S. T., & Patterson, C. J. (2004). Psychosocial adjustment, school outcomes, and romantic relationships of adolescents with same-sex parents. Child Development, 75, 1886–1898.
Ward, B. W., Dahlhamer, J. M., Galinsky, A. M., & Joestl, S. S. (2014). Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013 (National Health Statistics Reports No. 77). Hyattsville, MD: National Center for Health Statistics.
Williams, S. (2012). Child poverty in the United States, 2010 (NCFMR Family Profiles Report, No. FP-12-17). Bowling Green, OH: National Center for Family and Marriage Research. Retrieved from http://ncfmr.bgsu.edu/pdf/family_profiles/file115686.pdf
This work was supported in part by the following grants: The Office of the Director, National Institutes of Health, and the Eunice Kennedy Shriver National Institute of Child Health & Human Development (R03HD078754, PIs: Corinne Reczek, Hui Liu); The Ohio State University Institute for Population Research through a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development of the National Institutes of Health (P2CHD058484); and a K01 Mentored Research Scientist Career Development Award to Hui Liu (K01AG043417) from the National Institute on Aging.
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Reczek, C., Spiker, R., Liu, H. et al. Family Structure and Child Health: Does the Sex Composition of Parents Matter?. Demography 53, 1605–1630 (2016). https://doi.org/10.1007/s13524-016-0501-y