emotional health across the transition to first and second unions among emerging adults

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Research by Sara E. Mernitz and Claire Kamp Dush

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Page 1: Emotional Health Across the Transition to First and Second Unions Among Emerging Adults
Page 2: Emotional Health Across the Transition to First and Second Unions Among Emerging Adults

Emotional Health Across the Transition to First and Second UnionsAmong Emerging Adults

Sara E. Mernitz and Claire Kamp DushThe Ohio State University

The link between romantic relationships and emotional health has been extensively examined andsuggests that marriage provides more emotional health benefits than cohabiting or dating relationships.However, the contemporary context of intimate relationships has changed and these associations warrantreexamination among emerging adults in the 2000s. We examined the change in emotional health acrossthe entrance into first and second unions, including cohabiting unions, direct marriage (marriage withoutpremarital cohabitation), and marriage preceded by cohabitation. Using the National Longitudinal Surveyof Youth, 1997, a nationally representative panel study of youth born between 1980 and 1984 in theUnited States, pooled fixed-effects regression models indicated that entrance into first cohabiting unionsand direct marriages, and all second unions, were significantly associated with reduced emotionaldistress. Gender differences were found for first unions only; for men, only direct marriage wasassociated with an emotional health benefit, while both direct marriage and cohabitation benefitedwomen’s emotional health.

Keywords: emotional health, union formation, marriage, cohabitation, emerging adulthood

Romantic unions, including cohabitation and marriage, provideindividuals with tangible benefits (i.e., financial resources; Mar-cussen, 2005), and less tangible benefits (i.e., emotional support;Frech & Williams, 2007). The link between different types ofromantic relationships and emotional health has been extensivelyexamined; marriage provided more emotional health benefits thancohabiting or dating relationships (Kamp Dush & Amato, 2005).However, the contemporary context of intimate relationships haschanged and these associations warrant reexamination. Indeed,young adults now expect marriage to provide opportunities forself-esteem and personal growth (Finkel, Hui, Carswell, & Larson,2014), contributing in part to delayed first marriage and increasedrates of cohabitation (Cherlin, 2010).

This contemporary context of marriage makes marriage difficultto attain in certain populations. For example, Schwartz and Mare(2005) found that those with less education were more likely tocohabit, and not transition into marriage, compared to those withmore education; young adults with a history of depression werealso less likely to marry (Sandberg-Thoma & Kamp Dush, 2014).Past contemporary examinations into the links between relation-ship status and emotional health have not considered these pre-existing differences (e.g., Kim & McKenry, 2002). Further, be-cause the number of individuals who have had multiple unions hasincreased over time (Cherlin, 2004), examining associations be-tween higher-order unions and emotional health is critical. Using

a contemporary, nationally representative sample of emergingadults who entered unions in the 2000s and modeling that carefullyaccounted for selection into romantic unions based on emotionalhealth, we examined change in emotional distress across the tran-sition to first and second romantic unions. We also tested forpotential gender differences.

Emerging Adulthood and Romantic Unions

Emerging adulthood is defined as a unique developmental pe-riod for those in their late teens and early 20s (Arnett, 2000).According to identity theory and emerging adulthood theory,emerging adult romantic relationships have become increasinglyimportant as they contribute to identity development (Arnett,2000) and help foster intimacy (Erikson, 1968). In early adoles-cence, intimate relationships are often transient and recreational,whereas emerging adult relationships are more serious and long-term (Arnett, 2000). During the emerging adult years, intimaterelationships become more meaningful as these adults desire bothphysical and emotional intimacy (Arnett, 2000) and romanticpartners serve as the primary source of social and emotionalsupport (Seiffge-Krenke, 2003). Thus, establishing romanticunions during this period is a critical developmental task withpotential implications for emotional health.

Today’s emerging adults commonly engage in a variety ofrelationship experiences in pursuit of long-lasting romantic rela-tionships, and often transition into and out of multiple relation-ships. When Erikson (1968) first theorized the central task ofintimacy versus isolation in the young adult developmental stage,cohabitation was uncommon and often marginalized and hiddenfrom the public (Furstenberg, 2011). As cohabitation rates in-creased (Cherlin, 2010), a variety of premarital dating experiencesemerged (Arnett, 2000), and entrance into multiple unions, espe-cially cohabitation, has become commonplace (Cherlin, 2004).

Sara E. Mernitz and Claire Kamp Dush, Human Development and FamilyScience, Department of Human Sciences, The Ohio State University.

Correspondence concerning this article should be addressed to Sara E.Mernitz, Human Development and Family Science, The Ohio State Uni-versity, 135 Campbell Hall, 1787 Neil Avenue, Columbus, OH 43210.E-mail: [email protected]

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Journal of Family Psychology © 2015 American Psychological Association2015, Vol. 29, No. 5, 000 0893-3200/15/$12.00 http://dx.doi.org/10.1037/fam0000159

1

Page 3: Emotional Health Across the Transition to First and Second Unions Among Emerging Adults

Given these changes, contemporary examinations into the linkbetween emotional health and unions should consider cohabitationand higher-order cohabitation.

Romantic Unions and Emotional Health

Marriage

The marital resource model suggests that marriage providesmany additional benefits that improve emotional health (Umber-son, Thomeer, & Williams, 2013; Williams & Umberson, 2004);these benefits range from socioeconomic resources (Marcussen,2005) to social support that act as a buffer against daily lifestressors (Frech & Williams, 2007). This association betweenemotional health and marriage has also been found in more con-temporary emerging adult samples from the mid-1990s to early2000s; married emerging adults reported lower psychological dis-tress and greater life satisfaction compared with single and cohab-iting emerging adults (Uecker, 2012). When compared with singleor cohabiting individuals, married individuals reported increasedpsychological well-being (Kim & McKenry, 2002) and decreaseddepressive symptoms (Brown, 2000; Lamb, Lee, & DeMaris,2003). Further, an individual’s transition from being single intodirect marriage, or marriage not preceded by cohabitation, wasalso linked to emotional health improvements (Musick & Bump-ass, 2012). These between-groups and within-person results fromprior studies relied on data from the National Survey of Familiesand Households in the late 1980s and early 1990s.

Despite the benefits of marriage, the role of marriage in theUnited States has changed over time. Young adults marry later inthe life course, sex outside of marriage is no longer taboo, non-marital cohabitation and childbirth are at historic levels, and thereare more unmarried Americans than ever before (Cherlin, 2010).Finkel et al. (2014) suggested that marital partners fulfil higherneeds (i.e., personal growth), thus, marriage required significantpsychological investment. Although marriage is considered a sym-bolic achievement of success and many youth desire marriage(Cherlin, 2004), this new perception of marriage with its increas-ingly high standards (Edin & Reed, 2005; Finkel et al., 2014),makes marriage unattainable for some youth. For instance, mar-riage was less likely for those with a history of depression(Sandberg-Thoma & Kamp Dush, 2014), greater economic disad-vantage (Lichter, Qian, & Mellott, 2006), and less education(Schwartz & Mare, 2005). Given these changes in the role ofmarriage, examining links between marriage and emotional healthin a contemporary context is warranted.

Cohabitation

The link between cohabitation and emotional health is lessestablished than the link between marriage and emotional health.Lamb et al. (2003) found that cohabiting unions were not associ-ated with emotional health, compared with those who remainedunpartnered. Musick and Bumpass (2012) found that an individu-al’s transition from an unpartnered status into a cohabiting unionwas linked to improved emotional health. When cohabiting indi-viduals were compared with married individuals, cohabitors re-ported worse emotional health than their married counterparts(Brown, 2000; Kim & McKenry, 2002). In instances where rela-

tionship status was measured on a continuum, ranging from single(not dating) to married, individuals who transitioned from datingrelationships into cohabitation increased in subjective well-being(Kamp Dush & Amato, 2005). However, much of the existingliterature failed to consider ways in which cohabiting individualsdiffered from married individuals. Cohabitation was overrepre-sented among these economically disadvantaged groups, measuredby education, income, employment, and family backgrounds(Lichter & Qian, 2008). Further, children exacerbated depressionin cohabiting unions, but not married unions (Brown, 2000). Thus,change in emotional health may be because of pre-existing differ-ences between groups, which between-groups comparisons areunable to capture; existing research that fails to account for thesepre-existing differences likely biases the observed effect of cohab-itation on emotional health.

Whether there is an effect of marriage among contemporarycohabiting couples has yet to be established. Among NationalSurvey of Families and Household (NSFH) participants who mar-ried in the late 1980s and early 1990s, transitioning into marriagefrom a current cohabitation or from a noncohabiting relationship(what we call direct marriage) was associated with emotionalhealth benefits (Musick & Bumpass, 2012). Given the large per-centage of couples cohabiting before marriage (63% in the late2000s; Manning & Cohen, 2012), understanding whether therewas any additional benefit of marriage for emotional health hasimportant policy implications. Indeed, significant cost and timehas gone into the creation and implementation of government-supported Healthy Marriage Initiatives (HMIs), or programs de-signed to help couples form and maintain healthy marriages,despite the lack of success of these policies (Johnson, 2012;Manning, Brown, Payne, & Wu, 2014). If individuals receivedsimilar emotional health benefits regardless of union type, thenmarriage promotion efforts for these young adults may not usefulfor emotional health purposes.

Further, the investment model (Rusbult, 1980) suggested thatmarriage represents an additional, significant investment into therelationship, potentially bolstering commitment, relationship sat-isfaction, and emotional health. However, modern marital theorists(Finkel et al., 2014) have argued that personal expectations andstandards for marriage have become impossibly high. Thus, mod-ern premarital cohabitors may have been disappointed that mar-riage did not change more in their relationship, in line with theirhigher standards. In this case, transitions from cohabitation tomarriage may be associated with decreased emotional health.

Higher-Order Unions

There is little research on remarriage and emotional health, andthere is virtually no research on second cohabitations andemotional health. Overall, within-person remarriage providedemotional health benefits (Strohschein, McDonough, Monette, &Shao, 2005), yet these health benefits were less in magnitude thanthose gained from first marriages (Barrett, 2000). An individual’sentrance into cohabitation after divorce was also linked to im-proved subjective well-being (Mastekaasa, 1994). Higher-orderunions may have provided better emotional health outcomes; ex-periencing a first union dissolution might have encouraged emerg-ing adults to be more selective of subsequent partners, and, thus,they may have entered into higher-quality subsequent unions.

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2 MERNITZ AND KAMP DUSH

Page 4: Emotional Health Across the Transition to First and Second Unions Among Emerging Adults

Because low-quality unions were consistently linked to decreasedpsychological well-being (Hawkins & Booth, 2005), leaving theseunions may have allowed individuals to enter into subsequentunions with new romantic partners that may have been of higherquality, which likely improved emotional health. The current studysought to address this possibility by observing second union en-trance in addition to first union entrance.

Gender Differences in Emotional Health Benefits

Gender differences in the emotional health benefits from unionentrance are mixed. Compared with those who remained single,young adult men who married reported less depressive symptomsthan young adult women (Horwitz, White, & Howell-White,1996). However, more contemporary between-groups comparisonsfound no evidence of gender differences in the emotional healthbenefits of marriage or cohabitation, compared with remainingsingle (Blekesaune, 2008; Kim & McKenry, 2002). Thus, we didnot expect to observe gender differences in emotional health forfirst unions in our contemporary sample. Although higher-orderunions are rarely considered in studies examining emotional healthand romantic unions, a single study examining remarriage foundevidence that men received greater emotional health benefits fromremarriage than women (Williams, 2003). This evidence providesinitial support that second unions may be more beneficial formen’s emotional health.

Current Study

Longitudinal data from the National Longitudinal Survey ofYouth, 1997 was used to (a) examine within-person change inemotional health from entrance into a first cohabitation or mar-riage, (b) explore whether transitions into second cohabitation ormarriage provide similar emotional health benefits to first unions,and (c) examine possible gender differences. Based on the aims ofthis study, our hypotheses were:

Hypothesis 1: Transitioning from being single (never report-ing any union) into a first union, either marriage or cohabita-tion, and transitioning from a first union into a second union,either marriage or cohabitation, will be associated with de-creased emotional distress.

Hypothesis 2: Transitioning from cohabitation to marriagewith the same partner will be associated with decreased emo-tional distress for both first and second unions.

Hypothesis 3: There will be no observed gender differences inthe association between transitions into first unions and emo-tional distress.

Hypothesis 4: Men will be more likely than women to expe-rience decreased emotional distress from transitioning from afirst union into a second union.

Method

Participants and Procedures

We used the National Longitudinal Survey of Youth, 1997(NLSY97) data, a nationally representative study designed to

examine employment and education experiences, family formationpatterns, and family and community backgrounds of youth. Datawere collected from youth annually from 1997–2011; youth wereborn between 1980 and 1984 in the United States (n � 8,984).Youth were selected from over 90,000 housing units that werescreened for eligibility; all housing units within the continentalUnited States and the District of Columbia were considered. Ci-vilian, noninstitutional youth were deemed eligible for participa-tion if they were (a) between 12–16 years of age as of December31, 1996, and (b) living in the targeted household (in cases whereyouth could be linked to two or more households—e.g., parentaldivorce—youth were linked to their mother’s household). Youthwere interviewed annually using a 1-hr computer-assisted personalinterview (CAPI); questions relating to sensitive topics (e.g., druguse) were self-administered. The NLSY97 is a public dataset anda more detailed description of the measures, procedures, andinstruments is available online (https://www.nlsinfo.org/content/cohorts/nlsy97).

The current study used data from the 2000 –2010 surveyyears, as the dependent variable, emotional health, was onlyassessed biannually in even years. As individuals could havereported entrance into a romantic union before our first assess-ment of emotional health, we considered the first romanticunion to be the first union at, or after, year 2000 (whenemotional health is first assessed); 1.94% of the 8,984 respon-dents reported a first union entrance before 2000 and wereeliminated from our analyses. Overall, the analytic sample (n �8,700) was primarily White, employed part-time, and had a highschool degree. Men and women were represented equallywithin the sample, and the majority of the sample did not havea child. Youth were between 16 and 21 at the beginning of ourstudy (average age 18) and between 26 and 30 at the end of thestudy (average age 28); thus, the sample consisted of emergingadults. Out of the 45% who entered into a romantic union, 34%were first unions and 8% were higher-order unions with secondpartners (3% were unions with three or more partners). Firstcohabitations were most common (19%), followed by a directfirst marriage (9%), and transitions from first cohabitation tomarriage (5%). For unions with second partners, cohabitationswere most common (5%), followed by transitioning from co-habitation to marriage (2%), then direct marriage (1%).

To account for data missing at random because of nonresponse(21% data missing), we used multiple imputation using chainedequations (MICE). Chained equations imputation methods treateach variable as the dependent variable and regress all othervariables in the model onto the dependent variable (Johnson &Young, 2011). Using this method, dichotomous variables wereimputed using logistic regression and continuous variables wereimputed using ordinary-least squares regression. Further, we usedthe multiple imputation, then deletion (MID) technique (von Hip-pel, 2007), which recommends including the dependent variable inthe imputation model to help inform the values of the othervariable, but excluding imputed values for the dependent variablein the final analyses. Out of the initial 8,984, the final sample sizewas 8,700 after omitting individuals without information on thedependent variable (emotional distress) and omitting those whoentered into a union before the 2000 survey year.

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3UNION ENTRANCE AND EMOTIONAL HEALTH

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Variables

Emotional health (dependent variable). Emotional healthwas assessed at the 2000, 2002, 2004, 2006, 2008, and 2010 surveyyears using the 5-item Mental Health Inventory (MHI-5; Veit &Ware, 1983); the MHI-5 has been shown to be valid as an indicatorof depression and anxiety among adolescents and adults (Berwicket al., 1991; Ostroff, Woolverton, Berry, & Lesko, 1996). Respon-dents self-reported the occurrence of emotional health distress ona scale of 1 (all of the time) to 4 (none of the time). Symptoms wereassessed as how often in the last month respondents had (a) “beena very nervous person?”, (b) “felt calm and peaceful?”, (c) “feltdownhearted and blue?”, (d) “been a happy person?”, and (e) “feltso down in the dumps that nothing could cheer you up?” Questionsrelating to negative affect (Questions 1, 3, and 5) were reversecoded; scale items were totaled to produce the emotional healthscore. Thus, higher values on the scale indicated greater emotionaldistress. Respondents reported an average of 9.5 emotional distresssymptoms on a scale from 5–20. Scale reliabilities at each timepoint for the sample were acceptable, ranging from � � .77 to .82.

Romantic unions (independent variables). Union historieswere created from the marital and cohabitation data arrays; thesearrays included changes in marital and cohabitation status (Centerfor Human Resource Research, 2013). In the NLSY97, monthlychanges in the respondent’s marital and cohabitation status weremeasured at each survey year. First, we created annual unionhistories for both cohabitation and marital unions; 45% of respon-dents reported entrance into any union. For first cohabiting unions,we dichotomized the variable so that for each individual 1 � infirst cohabiting union and 0 � single where single was defined asnever having entered a union. First direct marriages were codedsimilarly where 1 � in first marital union without premaritalcohabitation and 0 � single. Transitions from cohabitation tomarriage were coded so that 1 � in marriage with former cohab-iting partner and 0 � cohabiting. In a few instances (� 1%),respondents reported both entrance into a first cohabiting unionand a first marriage during the same survey year; respondents werecoded as entering a direct first marriage.

Second cohabiting union were defined so that 1 � in cohabitingunion with a second partner and 0 � in first union. Second directmarriages were coded similarly so that 1 � in marital union thatwas not preceded by cohabitation with a second partner and 0 �in first union. Transitions from cohabitation to marriage werecoded so that 1 � in marriage with second cohabiting partner and0 � in first union. We also tested emotional health across thetransition from second cohabitation to marriage, and this wascoded so that 1 � in marriage with second cohabiting partner and0 � in second cohabiting union. Unlike first romantic unions,there were no instances where respondents reported both entranceinto a marital union and cohabiting union with a second partnerduring the same survey year; these categories were mutuallyexclusive.

Time-varying controls. Controls used in all models were thedichotomous, time-varying indicators of biological children, edu-cation, and employment status. Biological children were coded asan indicator of whether or not the respondent (or respondent’spartner) reported having given birth during the survey year. Edu-cation was coded into four response categories: less than highschool degree, high school degree (reference category), some

college, completed college or more education beyond college.Employment status was taken from the employment status historyfile and was coded dichotomously into three response categories:part time employment (reference category), full time employment,and not currently employed.

Analytic Plan

To test our hypotheses, we used pooled fixed-effects regressionmodels, also called change score models (Allison, 1990; Johnson,2005). Our null hypothesis was that union entrance was linked tono change in emotional distress for those who entered these unionscompared to those that remained single (or an alternative referencecategory). To illustrate how we examined change over time in achange score framework, we began with the equation for emo-tional distress at Time 1:

Distressi1� b0� b2Mi� b3Ui� b3Ti1� �i1 (1)

where b0 was a fixed constant, bj were the regression coefficients,Mi was a vector of measured time-invariant control variables, Ui

was a vector of unmeasured time-invariant control variables, andTi was a vector of measured time-variant control variables. εi wasthe error term. A similar equation could be written for Time 2, butthis equation would include the regression coefficient for the eventXi, union entrance. Union entrance could only occur after Time 1,hence it did not appear in the Equation 1.

Distressi2� b0� b1Xi� b2Mi� b3Ui� b3Ti2� �i1 (2)

To compute the change score model, the two equations weredifferenced as shown in Equation 3.

(Distressi2� Distressi1)� (b0� b0)� b1Xi� (b2Mi� b2Mi)

� (b3Ui� b3Ui)� (b4Ti2� b4Ti1)

� (�i2� �i1) (3)

Because Mi and Ui were time-invariant, as was b0, these weredifferenced out of the equation, and Equation 3 reduced to Equa-tion 4.

(Distressi2� Distressi1)� b1Xi� b4Ti ’� �i’ (4)

Thus, these models controlled for all time-invariant sources ofheterogeneity, both observed and unobserved, and the main threatsto validity were unobserved time-variant sources of heterogeneity.For example, race, family history, and any other time-invariantsource of heterogeneity were controlled for within these models,accounting for selection bias. Because individuals with greateremotional distress were more likely to cohabit and less likely tomarry (Sandberg-Thoma & Kamp Dush, 2014), the ability of thesemodels to account for selection bias based on initial levels ofemotional distress was critical. We had observations for more thantwo time points; thus, we conducted a pooled fixed-effects regres-sion models, where an individual’s outcome could be interpretedas their deviation away from the mean at each time point.

Hypothesis 1. For Hypotheses 1, that entrance into a first orsecond union, either cohabitation or direct marriage (marriagewithout premarital cohabitation), will be associated with decreasedemotional distress, we conducted several pooled fixed-effects re-

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4 MERNITZ AND KAMP DUSH

Page 6: Emotional Health Across the Transition to First and Second Unions Among Emerging Adults

gression models. We analyzed the emotional health implicationsfrom models where (a) individuals transitioned from being single(defined as never having entered into a cohabiting or maritalunion) to a first cohabitation, and (b) individuals transitioned frombeing single to direct marriage (defined as marriage without pre-marital cohabitation). For second unions, we analyzed the emo-tional health implications from models where individuals transi-tioned from a first union into a second union that was a (a)cohabiting union, (b) direct marriage, and (c) marriage precededby cohabitation with that same partner. Importantly, given theemotional health data limitations, we were unable to model emo-tional health across the transition from single after the first uniondissolved to entrance into a second union because individualsentered their second union often within two years of ending theirfirst union. However, we conducted pooled fixed-effects regres-sion models that compared single, preunion emotional distress to(a) cohabiting unions with second partners, (b) direct marriage tosecond partners, and (c) marriage preceded by cohabitationto second partners. These results are reported in the Appendix.

Hypothesis 2. For Hypothesis 2, that transitioning from co-habitation to marriage with a same partner will be associated withemotional distress for both first and second unions, we used pooledfixed-effects regression models. We analyzed the emotional healthimplications where (a) individuals transitioned from a first cohab-itation into a marriage with that same partner, and (b) individualstransitioned from a second cohabitation into a marriage with thatsame partner.

Hypotheses 3 and 4. Gender differences in the associationsbetween emotional health and first (and second) union entrancewere tested by analyzing all models separately by gender andtesting gender as a moderator in our analyses.

Results

Preliminary Analyses

Correlations and variance inflation factor statistics were exam-ined for multicollinearity among the variables; there was no mul-ticollinearity in our models. Weighted descriptive statistics arepresented in Table 1. Weighted statistics are presented because theNLSY97 oversamples certain respondents (i.e., Hispanic respon-dents); adjusting the data by weighting ensures that the sample isrepresentative of the population.

Hypothesis 1. Transitioning from being single (never report-ing any union) into a first union, either marriage or cohabitation,and transitioning from a first union into a second union, eithermarriage or cohabitation, will be associated with decreased emo-tional distress. Pooled fixed-effects regression models confirmedour first hypothesis (see Table 2, Models 1 and 2; see Table 3).Individuals who transitioned from being single to a first cohabi-tation or direct marriage significantly decreased in emotional dis-tress. Further, individuals who transitioned from a first union intoa cohabitation or marriage with a second partner, regardless ofpremarital cohabitation, decreased in emotional distress. Results

Table 1Full Sample Weighted Descriptive Statistics (n � 8,700)

Variables Mean (SD) % Range

Emotional distress symptoms 9.53 (2.45) — 5–20Single (no union) 55%Total unions 45%First unionsa 34%

Cohabitation 19%Direct marriage 9%Marriage after cohabitation 5%

Higher-order (second) unionsa 8%Cohabitation with second partner 5%Direct marriage with second partner 1%Marriage after cohabitation with second partner 2%

Emerging adult characteristicsAge 23.00 (3.47) — 16–30Female 49%Race

White 72%Black 15%Hispanic 13%

EducationLess than high school 19%High School 62%Some college 4%College degree 13%More than a college degree 2%

Employment statusNot employed 18%Part time employment 52%Full time employment 30%Had a child 7%

a Numbers do not add exactly to 45% of unions as 3% of unions were with greater than two partners.

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5UNION ENTRANCE AND EMOTIONAL HEALTH

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from pooled fixed-effects regression models that examined thetransition from being single to entering second unions are pre-sented in the Appendix. Similar to Table 3 results, transitioningfrom being single to entering into any union with a second partnerwas associated with decreased emotional distress.

Several control variables were significant in the models inTables 2 and 3. Individuals who give birth (or whose partner hadgiven birth) significantly decreased in emotional distress. In firstunion models examining cohabitation and direct marriage (Table2, Models 1 and 2), periods of unemployment were associated withincreased emotional distress whereas periods of full-time employ-ment were associated with decreased in emotional distress. Thesefindings were relatively consistent when examining second unionsregarding full-time employment, yet unemployed periods wereassociated with increased emotional distress only in the modelexamining cohabitation with a second partner (Table 3, Model 1).Among those who were in first unions and who married regardlessof cohabitation status (Table 3, Models 2 and 3), time spent withless than a high school education was associated with increasedemotional distress.

Hypothesis 2. Transitioning from cohabitation to marriage withthe same partner will be associated with decreased emotional distressfor both first and second unions. Inconsistent with Hypothesis 2,

transitioning into marriage from a first, current cohabitation (Table 2,Model 3) was not associated with change in emotional distress; theseresults held for second unions in that transitioning into marriage witha second, current cohabiting partner was also not associated with achange in emotional distress (b � � 0.14, p � .44). When examiningthe transition into marriage from a first cohabitation, control variablesindicated that only individuals who give birth (or whose partner hadgiven birth) significantly decreased in emotional distress (Table 2,Model 3); these results held when examining the transition intomarriage with second cohabiting partners (b � � 0.24, p � .001).Other significant control variables the model examining the transitioninto marriage with second cohabiting partners indicated that periodsof unemployment were associated with increased emotional distress(b � 0.22, p � .01) whereas periods of full-time employment wereassociated with decreased in emotional distress (b � � 0.17, p � .01).

Hypothesis 3. There will be no observed gender differences inthe association between transitions into first unions and emotionaldistress. Pooled fixed-effect regression models indicated that, in-consistent with Hypothesis 3, gender differences were observed inthe associations between transitions into first unions and emotionalhealth (see Table 4). For women, transitioning from being singleinto cohabitation or direct marriage was associated with significantreductions in emotional distress. For men, only transitioning from

Table 2Pooled Fixed-Effects Regression Predicting Change in Emotional Distress From FirstRomantic Unions

Model 1a Model 2b Model 3c

B SE B B SE B B SE B

First unionCohabitation � .10��� .03 — — — —Direct marriage — — � .24��� .04 — —Marriage after cohabitation — — — — � .02 .05

ControlsEducation (ref: high school)

Less than high school .05 .03 .05 .03 .13 .07Some college � .01 .05 � .01 .05 � .01 .10College � .01 .03 � .02 .03 .02 .08More college � .10 .09 � .06 .08 � .22 .16

Employment (ref: part time)Not employed .09��� .02 .08��� .03 .05 .05Full time � .07��� .02 � .07��� .02 � .03 .03Had a child � .09�� .03 � .09� .04 � .08� .04

Year2001 .02 .03 .02 .03 .07 .092002 .21��� .03 .21��� .03 .20� .082003 .21��� .03 .22��� .03 .21� .082004 � .13��� .03 � .12��� .03 � .18� .092005 � .11��� .03 � .09� .04 � .19� .092006 � .25��� .04 � .23��� .04 � .27�� .092007 � .24��� .04 � .21��� .04 � .27�� .092008 � .10�� .04 � .05 .04 � .05 .092009 � .09� .04 � .05 .04 � .05 .092010 � .26��� .04 � .27��� .05 � .21� .10

Person-yearsd 68,092 58,430 22,692n 8,227 7,643 4,435

Note. B � Beta coefficient; SE B � Standard error.a Model 1 included those who transitioned from being single (not in a union) into a first cohabitation. b Model2 included those who transitioned into a first direct marriage. c Model 3 included those who transitioned froma first cohabitation into marriage. d Person-years estimated how much time each participant contributed to thestudy.� p � .05. �� p � .01. ��� p � .001.

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6 MERNITZ AND KAMP DUSH

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being single into direct marriage was associated with significantdeclines in emotional distress; transitioning into marriage fromcohabitation or transitioning into cohabitation from being singlewere not associated with emotional distress. Interactions betweenfirst union status and gender indicated that there were significantdifferences between males and females for cohabitation(b � � 0.34, p � .001) and direct marriage (b � � 0.28, p � .001);there were no significant gender differences for transitioning intomarriage from a first cohabitation (b � � 0.16, p � .08). Further,in results not shown, transitioning into marriage with a second,current cohabiting partner was not associated with a change inemotional distress for either gender (men: b � � 0.14, p � .44;women: b � 0.16, p � .20). Significant control variables forwomen indicated that, in all models, periods with less than a highschool education were associated with increased emotional distress(see Table 4). For women, in models examining cohabitation anddirect marriage (Table 4, Models 1 and 2), periods of unemploy-ment were associated with increased emotional distress; full-timeemployment periods were associated with decreased emotionaldistress only in the model examining cohabitation (Table 4, Model1). For men, significant control variables indicated that full-timeemployment and having a partner give birth to a child wereassociated with decreased emotional distress for cohabitation anddirect marriage models (Table 4, Models 1 and 2).

Hypothesis 4. Men will be more likely than women to experi-ence decreased emotional distress from transitioning from a firstunion into a second union. Unexpectedly, higher-order unions with asecond partner were linked to reductions in emotional distress for bothgenders, across all union types (see Table 5). Transitioning from afirst union into a higher-order second union (direct marriage, cohab-itation, or marriage preceded by premarital cohabitation) were asso-ciated with decreased emotional distress. Interactions between unionswith second partners and gender indicated that there were no signif-icant gender differences for cohabitation (b � 0.02, p � .83), directmarriage (b � � 0.08, p � .61), and marriage preceded by cohabita-tion (b � 0.20, p � .20). Significant control variables indicated that,for women, models examining marriage (directly or via cohabitation),time spent with less than a high school education was associated withincreased emotional distress (Table 5, Models 2 and 3). For women,in the model examining premarital cohabitation (Table 5, Model 3),time spent with a college degree was associated with decreasedemotional distress. For both men and women, all models indicatedthat experiencing the birth of a child was associated with decreasedemotional distress. For men only, full-time employment periods wereassociated with decreased emotional distress (see Table 5); unemploy-ment was associated with increased emotional distress, but only in themodel examining cohabitation with second partners (Table 5, Model 1).

Table 3Pooled Fixed-Effects Regression Predicting Change in Emotional Distress From Romantic Unions With Second Partners

Model 1a Model 2b Model 3c

B SE B B SE B B SE B

Higher-order unionsCohabitation with second partner � .24��� .05 — —Direct marriage with second partner — � .35��� .08 —Marriage after cohabitation with second partner — — � .49��� .08

ControlsEducation (ref: high school)

Less than high school .07 .05 .15� .08 .13� .06Some college � .01 .08 � .11 .06 � .10 .08College � .01 .06 � .09 .08 � .08 .06More college � .09 .12 � .18 .06 � .16 .12

Employment (ref: part time)Not employed .11�� .04 .01 .04 .04 .04Full time � .06� .03 � .05 .03 � .06� .03Had a child � .14��� .03 � .11��� .03 � .12��� .03

Year2001 .05 .07 .05 .07 .06 .072002 .18�� .07 .19�� .07 .17� .072003 .22��� .07 .22�� .07 .21�� .072004 � .20�� .07 � .15� .07 � .16� .072005 � .19��� .07 � .14� .07 � .15� .072006 � .28��� .07 � .21�� .07 � .22�� .072007 � .27��� .07 � .20�� .07 � .21�� .072008 � .04 .07 .03 .07 .03 .072009 � .03 .07 .03 .07 .07 .072010 � .26��� .07 � .17� .07 � .18� .07

Person-yearsd 35,259 32,175 32,692n 6,034 5,969 5,957

Note. B � Beta coefficient; SE B � Standard error.a Model 1 included those who transitioned from a first union into cohabitation with a second partner. b Model 2 included those who transitioned into adirect marriage with a second partner. c Model 3 included those who transitioned into a marriage preceded by cohabitation with a second part-ner. d Person-years estimated how much time each participant contributed to the study.� p � .05. �� p � .01. ��� p � .001.

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Discussion

Emerging adulthood is a developmental period characterized byintimacy exploration where youth form sustainable romantic relation-ships (Arnett, 2000). Emerging adults enter and exit from a variety ofrelationships to accomplish this task, with potential implications foremotional health. Consistent with our first hypothesis, entrance intoany first union was associated with decreased emotional distresssymptoms, regardless of whether the union was a marriage or cohab-itation. Marriage has been consistently linked to better emotionalhealth compared to remaining single (e.g., Lamb et al., 2003); ourresults confirm this association in a contemporary sample of emergingadults, even when conducting stringent change score models (John-son, 2005). Further, our results provide support for the marital re-source model, which suggests that marriage provides many additionalbenefits that improve emotional health (Williams & Umberson,2004). Similarly, there has been some debate in the literature onwhether entrance into cohabitation is associated with improved emo-tional health (Lamb et al., 2003; Musick & Bumpass, 2012). Ourresults align with other studies examining within-person change (Mu-sick & Bumpass, 2012); contemporary emerging adult cohabitorsreceived emotional health benefits when they transitioned into cohab-itation from being single.

Our results regarding second unions stand in contrast to societalstigma around divorce, and the idea that serial cohabitation, or

cohabiting with multiple partners, is negative for subsequent rela-tionship stability. Consistent with our first hypothesis, we foundthat transitioning from a first union into cohabitation, or marriagewith a second partner, were linked to decreased emotional distress.Although union dissolution is associated with decreased emotionalhealth (Kamp Dush, 2013), we were unable to capture the emerg-ing adults’ time spent single between their unions because themovement from union to union was rapid. That said, we found anemotional health benefit of second unions over first unions andsingle before first union (see the Appendix). Emerging adults mayhave identified higher-quality romantic partners for subsequentunions after ending low-quality first unions. Although partnerselection after first unions has not been researched extensivelyamong young adults, previous evidence of unmarried mothers inthe Fragile Families and Child Wellbeing dataset found that moth-ers selected higher-quality partners, in terms of employment, ed-ucation, and incarceration history, for subsequent romantic unions(Bzostek, McLanahan, & Carlson, 2012). Dissolving these earlylow-quality romantic unions, and entering into subsequent unionswhere young adults might be more selective of second partners,may ultimately improve an individual’s emotional health. Moreresearch needs to be conducted on repartnering across the lifecourse and the mechanisms and mate selection processes occurringin a contemporary context.

Table 4Pooled Fixed-Effects Regression Predicting Change in Emotional Distress From First Romantic Unions by Gender

Model 1a Model 2b Model 3c

FemaleB (SE)

MaleB (SE)

FemaleB (SE)

MaleB (SE)

FemaleB (SE)

MaleB (SE)

First unionsCohabitation � .19��� (.04) .01 (.04) — — — —Direct marriage — — � .30��� (.05) � .17��� (.05) — —Marriage after cohabitation — — — — � .12 (.07) .08 (.08)

ControlsEducation (ref: high school)

Less than high school .10� (.04) .01 (.04) .09� (.05) .02 (.04) .19 (.11) .08 (.09)Some college � .02 (.07) .04 (.07) � .07 (.07) .10 (.07) � .01 (.13) � .01 (.16)College .05 (.04) � .03 (.05) .02 (.05) � .02 (.05) .02 (.10) .03 (.13)More college � .14 (.11) .08 (.14) � .19 (.11) .16 (.12) � .25 (.19) � .10 (.30)

Employment (ref: part time)Not employed .12��� (.04) .06 (.03) .12��� (.04) .04 (.03) .05 (.05) .07 (.07)Full time � .07� (.03) � .09��� (.03) � .05 (.03) � .09��� (.03) � .03 (.04) � .05 (.05)Had a child � .08 (.05) � .11� (.05) � .05 (.05) � .15�� (.06) .09 (.05) � .06 (.06)

Year2001 .05 (.04) .01 (.04) .04 (.04) .01 (.04) .12 (.11) � .01 (.14)2002 .14��� (.04) .27��� (.04) .14�� (.05) .29��� (.04) .27� (.11) .10 (.13)2003 .15��� (.05) .27��� (.04) .15��� (.05) .29��� (.04) .32�� (.11) .06 (.13)2004 � .26��� (.05) � .02 (.04) � .29��� (.05) .02 (.05) � .05 (.11) � .34� (.13)2005 � .23��� (.05) � .01 (.05) � .25��� (.05) .05 (.05) � .05 (.11) � .38�� (.13)2006 � .42��� (.05) � .12� (.05) � .39��� (.06) � .10� (.05) � .18 (.11) � .38�� (.13)2007 � .39��� (.06) � .13� (.05) � .38��� (.06) � .08 (.05) � .15 (.11) � .42�� (.13)2008 � .22��� (.06) � .02 (.05) � .19�� (.06) .05 (.05) .11 (.12) � .24 (.14)2009 � .21��� (.06) � .01 (.05) � .17�� (.06) .04 (.06) .13 (.12) � .25 (.14)2010 � .43��� (.06) � .14� (.05) � .42��� (.06) � .17�� (.06) � .13 (.12) � .33� (.14)

Person-yearsd 31,016 37,076 26,362 32,068 11,998 10,694n 3,916 4,311 3,600 4,043 2,277 2,158

Note. B � Beta coefficient; SE B � Standard error.a Model 1 included those who transitioned from being single (not in a union) into a first cohabitation. b Model 2 included those who transitioned frombeing single into a first direct marriage. c Model 3 included those who transitioned from a first cohabitation into marriage. d Person-years estimated howmuch time each participant contributed to the study.� p � .05. �� p � .01. ��� p � .001.

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The investment model (Rusbult, 1980) suggests that marriage is anindicator of an additional investment into the relationship, which, inturn, bolsters relationship commitment and satisfaction and emotionalhealth. We were able to use our data to examine whether marriage hadan effect on emotional health among cohabitors who were alreadyliving together. Inconsistent with our second hypothesis, we found noevidence of change in emotional health across the transition to mar-riage among cohabitors. Thus, our findings suggest that the invest-ment model might apply to both cohabitation and marriage; emergingadults receive emotional health benefits from unions, regardless ofunion type, and no additional benefit of formalizing cohabitation intomarriage. This finding stands in contrast to Musick and Bumpass(2012) findings for cohabitors marrying their partner in the late1980s/early 1990s; Musick and Bumpass found an emotional healthbenefit when current cohabitors transitioned into marriage. Becausenonmarital cohabitation is more socially acceptable today than inprevious years (Furstenberg, 2011) and cohabitation rates are at his-toric levels (Cherlin, 2010), any social stigma associated with cohab-itation may have been reduced to the point that there are benefits ofentering cohabitation. According to our analyses, entering marriagefrom a current cohabitation was not linked to emotional health, andthese results held for cohabitors marrying their first or second partner,and for men and women. Because modern marital theorists suggestthat marital standards have become impossibly high (Finkel et al., 2014),

any benefit that marriage conferred for emotional health may have beenoffset by disappointment that marital expectations were not met.

From a clinical perspective, clinicians working with single in-dividuals in their twenties may encourage healthy intimate rela-tionship skills, such as conflict management, because we foundthat transitioning from a nonunion into a union is associated withimproved emotional health. In working with young adults inunions, clinicians may be confident in suggesting that an individ-ual consider leaving an unhealthy union because our results sug-gest that a subsequent union could lead to positive emotionalhealth outcomes. Clinicians who focus their clinical work oncouples might caution these couples that transitioning from cohab-itation to marriage will not improve their individual well-being asmuch as the couple believes it might.

Gender Differences

The change in emotional health across union entrance differed bygender in ways inconsistent with our third and fourth hypotheses. Forfirst unions, men experienced a decrease in emotional distress fromdirect marriage only whereas women experienced a decline in emo-tional distress from both direct marriage and cohabitation. Marriagepreceded by cohabitation was not associated with emotional health forboth genders. There were no gender differences for second unions;

Table 5Pooled Fixed-Effects Regression Predicting Change in Emotional Distress From Romantic Unions With Second Partners by Gender

Model 1a Model 2b Model 3c

FemaleB (SE)

MaleB (SE)

FemaleB (SE)

MaleB (SE)

FemaleB (SE)

MaleB (SE)

Cohabitation with second partner � .23��� (.06) � .24��� (.07) — — — —Direct marriage with second partner — — � .38��� (.10) � .28� (.12) — —Marriage after cohabitation with second partner — — — — � .46��� (.10) � .57��� (.13)Controls

Education (ref: high school)Less than high school .12 (.08) .03 (.07) .23�� (.08) .07 (.08) .21� (.08) .05 (.08)Some college � .05 (.10) .07 (.12) � .17 (.10) � .02 (.13) � .17 (.10) � .01 (.13)College � .05 (.08) .07 (.10) � .15 (.08) � .01 (.10) � .15� (.08) .02 (.10)More college � .16 (.16) .08 (.20) � .28 (.16) � .02 (.20) � .26 (.15) � .01 (.20)

Employment (ref: part time)Not employed .07 (.05) .18�� (.06) � .01 (.05) .06 (.06) .01 (.05) .10 (.06)Full time � .05 (.04) � .08� (.04) � .01 (.04) � .10�� (.04) .02 (.04) � .11�� (.04)Had a child � .17��� (.04) � .08 (.04) � .13��� (.04) � .08 (.05) � .13��� (.04) � .09� (.05)

Year2001 .12 (.09) � .06 (.12) .10 (.09) � .04 (.12) .11 (.09) � .04 (.12)2002 .21� (.09) .12 (.11) .24�� (.09) .10 (.12) .20� (.09) .11 (.12)2003 .27�� (.09) .14 (.11) .31��� (.09) .08 (.11) .27�� (.09) .09 (.11)2004 � .16 (.09) � .26� (.11) � .08 (.09) � .29�� (.11) � .08 (.09) � .30�� (.11)2005 � .14 (.09) � .27� (.11) � .05 (.09) � .29�� (.11) � .05 (.09) � .30�� (.11)2006 � .25�� (.09) � .33�� (.11) � .12 (.09) � .34�� (.11) � .13 (.09) � .36�� (.11)2007 � .24�� (.09) � .34�� (.11) � .10 (.09) � .35�� (.11) � .11 (.09) � .37��� (.11)2008 .03 (.09) � .14 (.11) .14 (.09) � .14 (.11) .15 (.09) � .15 (.11)2009 .05 (.09) � .15 (.11) .15 (.09) � .15 (.11) .17 (.09) � .16 (.12)2010 � .27� (.09) � .33�� (.11) � .11 (.09) � .29� (.12) � .12 (.09) � .30�� (.12)

Person-yearsd 19,020 16,239 17,382 14,793 17,840 14,852n 3,145 2,889 3,097 2,872 3,090 2,867

Note. B � Beta coefficient; SE B � Standard error.a Model 1 included those who transitioned from a first union into cohabitation with a second partner. b Model 2 included those who transitioned into adirect marriage with a second partner. c Model 3 included those who transitioned into a marriage preceded by cohabitation with a second part-ner. d Person-years estimated how much time each participant contributed to the study.� p � .05. �� p � .01. ��� p � .001.

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both men and women who transitioned from being single into a firstunion or from a first union into a second union received emotionalhealth benefits. Gender differences observed in first unions may occurbecause reasons for entering these unions differ by gender. Men weremore likely than women to report cohabiting as a way to test arelationship, and cohabiting as a relationship test was linked to sub-sequent relationship problems, such as negative communication pat-terns, greater physical aggression, and decreased commitment to therelationship (Rhoades, Stanley, & Markman, 2009). These relation-ships problems may offset any health benefit gained from enteringinto cohabitation (or transitioning from cohabitation into marriage).Men who marry directly are unlikely to view their marriage as arelationship “test” and may be better able to enjoy the benefits, andinvest more in, the marriage.

The observed gender differences in first unions may also be be-cause of the focus on emotional health rather than behavioral health.Emotional indicators of health, such as measures assessing anxietyand depression, are more accurate in evaluating women’s emotionaldistress, whereas behavioral indicators, such as alcohol problems orviolence, are more accurate at identifying distress among men (Si-mon, 2002). Further, men are more likely than women to underreportemotional distress on self-reported scales (Sigmon et al., 2005). Be-havioral health benefits of entrance into a first union may be morepronounced for men than women.

Limitations and Future Research

We acknowledge some limitations in our study. Given data restric-tions, emotional health was only assessed biannually from the 2000 to2010 survey years. Romantic union entrances and exits are commonduring this period (Arnett, 2000); thus, a more frequent measurementof emotional distress would reduce measurement error. Further, an-nual or monthly measurement of emotional health might allow re-searchers to identify subtle nuances in emotional health status thatmay exist short-term because of union dissolution or in the earlymonths of union entrance. Additionally, we had no indicator ofrelationship quality for each romantic union; relationship quality wasonly asked to a select sample during the 2004 survey year. Endinglow-quality unions may be associated with less emotional distresswhereas remaining in low-quality unions or ending a high-qualityunion is likely associated with greater emotional distress. Indeed,women in low-quality marriages show higher life satisfaction follow-ing a divorce than women in low-quality marriages who remainmarried (Bourassa, Sbarra, & Whisman, 2015).

Further, we were unable to distinguish between same- anddifferent-sex couples in our study. Because same-sex youth were notlegally allowed to marry in many states during the data collectionperiod, they only had the option to cohabit with romantic partners.The emotional health benefits gained from these cohabiting unionsmay be comparable to those gained by cohabiting different-sex cou-ples or they may be comparable to those gained by married different-sex couples. Partnered gay and lesbian adults reported similar happi-ness to cohabiting different-sex couples (Wienke & Hill, 2008), yetlittle is known about whether these findings would be observed inemerging adult samples. Future research could examine these asso-ciations in younger samples. Further, as the legality of same-sexmarriage changes, research should look for evidence of a “marriage-effect” on health for this population.

Our findings provide insight into the links between emotionalhealth and unions in a large, nationally representative dataset, butthere are likely different implications by culture. In cultures that holdmore conservative values, cohabitation may not be accepted andcohabiting youth may face societal stigma surrounding their decisionto cohabit, with emotional health implications. Indeed, the emotionalhealth benefits of marriage are often more pronounced in collectivistnations that typically hold more conservative values, than in individ-ualist nations (Diener, Gohm, Suh, & Oishi, 2000). However, thisresearch question has not been extensively examined for young,contemporary samples. Future research may want to address this ques-tion and examine emotional health of youth in higher-order unions.

Conclusion

Despite these limitations, this study provided insight into the asso-ciation between union entrance and emotional health. Because paststudies often compared emotional health outcomes among groups ofindividuals in various relationship statuses, it was unclear whetherindividual characteristics that selected individuals into a particularrelationship status were associated with emotional health, or the unionitself. For example, pre-existing depression predisposes individuals toenter into cohabitation rather than marriage (Sandberg-Thoma &Kamp Dush, 2014) and between-person comparisons between unionsmay show poorer emotional health for cohabitors than marrieds.Examining within-person change allowed us to account for time-invariant sources of selection and better isolate the effect of unionentrance on emotional health.

Further, the meaning of cohabitation and marriage has shifted overtime (Furstenberg, 2011) and it is likely that emotional health out-comes from entrance into these unions have shifted over time as well.More emerging adults enter into cohabiting unions today, in additionto other premarital relationship experiences, in comparison to otherage groups (Arnett, 2000; Cherlin, 2010). Findings from older adultsamples regarding the emotional health outcomes from entrance intoromantic unions cannot be directly comparable to those for emergingadult samples. Our study used a contemporary sample of Americanemerging adults and we still found an emotional health benefit ofmarriage, but we also found an emotional health benefit of cohabita-tion. Our findings suggest that even in modern intimate relationships,unions improve emotional health and the legal formality of suchunions may be less important than in the past.

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Appendix

Pooled Fixed-Effects Regression Predicting Change in Emotional Distress From Romantic UnionsWith Second Partners

Model 1a Model 2b Model 3c

B SE B B SE B B SE B

Higher-order unionsCohabitation with second partner � .15�� .06 — — — —Direct marriage with second partner — — � .29��� .09 — —Marriage after cohabitation with second partner — — — — � .28�� .11

ControlsEducation (ref: high school)

Less than high school .02 .03 .04 .03 .04 .03Some college .06 .06 .02 .06 .03 .06College .01 .04 � .02 .04 � .02 .04More college � .06 .09 � .12 .10 � .14 .09

Employment (ref: part time)Not employed .10��� .03 .08��� .03 .08�� .03Full time � .09��� .02 � .07��� .02 � .08��� .02Had a child � .07 .04 � .04 .05 � .05 .05

Year2001 .01 .03 .01 .03 .02 .032002 .21��� .03 .22��� .03 .22��� .032003 .22��� .03 .21��� .03 .22��� .032004 � .13��� .04 � .12��� .04 � .11��� .042005 � .10�� .04 � .09� .04 � .08� .042006 � .26��� .04 � .24��� .04 � .24��� .042007 � .23��� .04 � .20��� .04 � .20��� .042008 � .09� .04 � .11� .04 � .08 .042009 � .09� .04 � .10� .04 � .08 .042010 � .35��� .04 � .29��� .05 � .27��� .05

Person-yearsd 55,508 51,602 51,739n 7,936 7,559 7,496

Note. B � Beta coefficient; SE B � Standard error.a Model 1 included those who transitioned from being single (not in a union) into cohabitation with a second partner. b Model 2 included those whotransitioned into a direct marriage with a second partner. c Model 3 included those who transitioned into a marriage preceded by cohabitation with asecond partner. d Person-years estimated how much time each participant contributed to the study.� p � .05. �� p � .01. ��� p � .001.

Received January 7, 2015Revision received August 26, 2015

Accepted September 2, 2015 �

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12 MERNITZ AND KAMP DUSH