An old joke poses the question, “Do married people live longer?” The tongue-in-cheek punch line is, “Not really, it only seems longer.” In fact, not only do married people, particularly men, live longer, but research shows that they also are mentally and physically healthier than nonmarried people. When matched for age, race, and sex, married people have less cancer, heart disease, and other disorders than divorced people. It is not clear whether these health benefits result from being married or whether physically and emotionally well people are more likely to be married. In either case, in the United States, the average age of first marriage is about 25 years for women and 27 years for men. By age 30, most Americans are married.

With marriage, the birth of a child, or the adoption of a child, a new family is formed. Although there are many types of families in the United States, the most common type of family includes mother, father, and dependent children (i.e., under age 18 years) living together in one household—a configuration known as the nuclear family.

Approximately 60% of American children live with their married biological parents (Harden, 2001). Other types of American families include cohabiting heterosexual and gay parent families and single-parent families. The extended family includes other family members such as grandparents who, in this country, usually live outside of the nuclear household.

In most two-parent American families, both parents work and, in 2007, median household money income was about $50,000. Both parents work outside the home in more than half of all married couples with at least one child of preschool age and almost 70% of couples with school-age children. Only about 25% of children live in a traditional family configuration, in which the father works outside of the home and the mother is a fulltime homemaker. No matter what the family configuration, parenting children is expensive; the cost of raising a child to age 18 years in the United States is more than $200,000. And, as medical students and their families know too well, postsecondary education can effectively double this figure.

Currently, close to half of all marriages in the United States end in divorce. Unhappily, when at least one spouse is a physician, the divorce rate is up to 20% higher than when neither spouse is a physician. A study of graduates of The Johns Hopkins
University School of Medicine from 1948 through 1964 showed that, among married physicians, gender, specialty choice, and time of marriage were related to rates of divorce. Female physicians, physicians choosing psychiatry, and medical students married before medical school graduation had the highest divorce rates (Rollman et al., 1997).

In the general American population, factors that have been associated with the high rate of divorce include short length of the courtship period, marriage during teenage years, and premarital pregnancy. Other factors relate to the couple’s family of origin and include absence of family support for the couple, prior divorce in the family, and differences in religion or socioeconomic background between the couple. Although it might be expected that life stress draws couples together, the unfortunate reverse seems to be true. Couples that experience the serious illness or death of a child are more likely than other couples to divorce.

In 2010, approximately 27% of American children lived in single-parent families, a percentage that varied by ethnic group (Table 3-1). Most single-parent families are headed by women and, although many unmarried mothers belong to low socioeconomic groups, the fastest growing population of single mothers is actually made up of educated, professional women who choose to bear or adopt children on their own.

Single-parent families face unique challenges. Studies have consistently demonstrated that all members of single-parent families are at increased risk for physical and mental illness. Although the issue is complex, it is believed that the lower incomes and less social support that characterize single-parent families are related to this increased risk. Another sobering finding of this research is that children whose parents divorce are at particularly high risk for failure in school, depression, drug abuse, suicide, criminal activity, and for divorce themselves in the future.

When the parental unit is broken, it must be decided which of the involved adults will have custody, or primary responsibility for the children, and with whom the children will live. Until the last few decades, the most common type of custody arrangement after divorce was sole custody. In this scheme, the parent with whom the child lived, usually the mother, had legal responsibility for the child and made decisions about his or her care. The other parent, usually the father, contributed to the child’s financial support and had the right to visit the child on a regular schedule. In recent years, joint residential custody has become more popular than sole custody. In this arrangement, the child spends part of the time living with each parent; the parents share legal responsibility and jointly make decisions about the child’s care. If the parents live close to each other, the child may spend part of the week with each parent. A now familiar sight for grade-school teachers is a child—toting a bulging backpack filled with clothing, toys, and schoolwork—arriving at school from his father’s home and leaving school bound for his mother’s home. If parents with joint custody live some distance from each other, the child may spend the school year with one and summers and vacations with the other.

An alternative custody choice is split custody. In this option, usually reserved for teenagers, each parent has custody of at least one child in the family. That child may be asked to choose which parent to live with, or his living situation may be decided for him by parents or ordered by the court. In contrast to past years, fathers are increasingly asking for and being granted the custodial care of their children. No matter what the custody type determined after divorce, children who continue to have regular contact with the noncustodial parent have fewer
emotional and behavioral problems than those who have no contact with that parent.