Measures

Decent Work

Decent work at Waves IV and V was measured using three indicators adapted from Duffy et al. (2017): (a) access to health insurance, (b) compensation, and (c) access to paid time off. Items included employer-provided health insurance (binary), earned income (continuous in Wave IV; ordinal scale in Wave V ranging from 1 = "<$5,000" to 12 = "$200,000 or more"), and paid vacation or sick leave (binary). Higher values indicate greater access to decent work characteristics.

Health Strain

Health strain was assessed based on the secondary allostatic load framework (Ganster et al., 2018), focusing on long-term physiological dysregulation. Biomarker domains included:

• Cardiovascular: systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR)
• Metabolic: body mass index (BMI), waist circumference, triglycerides, total cholesterol, HDL cholesterol, and hemoglobin A1c (HbA1c)
• Psychological: self-rated general health (1 = Excellent to 5 = Poor)

High-risk thresholds were defined as values above the 75th percentile (80th for triglycerides and total cholesterol; 20th for HDL). Individual markers were dichotomized and summed within domain-specific indices. Higher scores reflect greater health strain.

Depressive Symptoms

Depressive symptoms were measured using four items from the Center for Epidemiologic Studies Depression Scale (CES-D), administered across both waves. Respondents rated items such as “I felt that I could not shake off the blues” on a four-point scale (0 = Rarely to 3 = Most or all of the time). Higher total scores denote more severe depressive symptomatology.

Health-Risk Behaviors

Health-risk behaviors were operationalized using the following indicators:

• Smoking: calculated as the product of cigarettes smoked per day and the number of smoking days in the past month (log-transformed).
• Binge drinking: number of days in the past year on which respondents engaged in heavy episodic drinking (5+ drinks for men; 4+ for women).
• Illicit drug use: binary indicators of non-prescribed use of sedatives, tranquilizers, stimulants, or opioids, aggregated into a composite score.

All variables were coded such that higher values reflect greater engagement in health-risk behavior.

Survival Needs

Financial strain related to basic needs was measured using four dichotomous items from Wave IV (0 = No, 1 = Yes), including inability to pay for: (a) phone service, (b) full rent or mortgage, (c) utility bills, and (d) food insecurity (e.g., concern about food running out). Responses were summed; higher scores indicate greater unmet survival needs.

Autonomy

Perceived autonomy was assessed via four items adapted from the Pearlin Mastery Scale (Pearlin & Schooler, 1978). Items (e.g., “I have little control over the things that happen to me”) were rated on a five-point Likert scale (1 = Strongly agree to 5 = Strongly disagree) and reverse-coded. Composite scores reflect higher levels of autonomy.

Covariates

Demographic covariates included:

• Ethnicity: recoded as White (1) vs. Non-White (0)
• Sex: male (1), female (2), based on Wave I biological sex
• Age: calculated from date of birth and interview date
• Marital status: coded as 0 = never married, 1 = currently or previously married

Note: Data on gender identity and sexual orientation were not available in Wave I.