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Harper LJ, Culver DA, Cozier YC. Race and class in big data. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2024; 41:e2024001. [PMID: 38940705 PMCID: PMC11275539 DOI: 10.36141/svdld.v41i2.16149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Logan J Harper
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel A Culver
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yvette C Cozier
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118-2526, USA
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Nair D, Schildcrout JS, Shi Y, Trochez R, Nwosu S, Bell SP, Mixon AS, Welch SA, Goggins K, Bachmann JM, Vasilevskis EE, Cavanaugh KL, Rothman RL, Kripalani SB. Patient-reported predictors of postdischarge mortality after cardiac hospitalization. J Hosp Med 2024; 19:475-485. [PMID: 38560772 PMCID: PMC11147709 DOI: 10.1002/jhm.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Adults hospitalized for cardiovascular events are at high risk for postdischarge mortality. Screening of psychosocial risk is prioritized by the Joint Commission. We tested whether key patient-reported psychosocial and behavioral measures could predict posthospitalization mortality in a cohort of adults hospitalized for a cardiovascular event. METHODS We conducted a prospective cohort study to test the prognostic utility of validated patient-reported measures, including health literacy, social support, health behaviors and disease management, and socioeconomic status. Cox survival analyses of mortality were conducted over a median of 3.5 years. RESULTS Among 2977 adults hospitalized for either acute coronary syndrome or acute decompensated heart failure, the mean age was 53 years, and 60% were male. After adjusting for demographic, clinical, and other psychosocial factors, mortality risk was greatest among patients who reported being unemployed (hazard ratio [HR]: 1.99, 95% confidence interval [CI]): 1.30-3.06), retired (HR: 2.14, 95% CI: 1.60-2.87), or unable to work due to disability (HR: 2.36, 95% CI: 1.73-3.21), as compared to those who were employed. Patient-reported perceived health competence (PHCS-2) and exercise frequency were also associated with mortality risk after adjusting for all other variables (HR: 0.86, 95% CI: 0.73-1.00 per four-point increase in PHCS-2; HR: 0.86, 95% CI: 0.77-0.96 per 3-day increase in exercise frequency, respectively). CONCLUSIONS Patient-reported measures of employment status, perceived health competence, and exercise frequency independently predict mortality after a cardiac hospitalization. Incorporating these brief, valid measures into hospital-based screening may help with prognostication and targeting patients for resources during post-discharge transitions of care.
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Affiliation(s)
- Devika Nair
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan S Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ricardo Trochez
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sam Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan P Bell
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sarah A Welch
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin M Bachmann
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Kerri L Cavanaugh
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Russell L Rothman
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil B Kripalani
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, VUMC, Nashville, Tennessee, USA
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Xu J, Falkenstein MJ, Kuckertz JM. Feeling more confident to encounter negative emotions: The mediating role of distress tolerance on the relationship between self-efficacy and outcomes of exposure and response prevention for OCD. J Affect Disord 2024; 353:19-26. [PMID: 38423365 PMCID: PMC11059676 DOI: 10.1016/j.jad.2024.02.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND While exposure and response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD), up to half of patients do not effectively respond. In an effort to better understand the mechanisms behind ERP, the inhibitory learning model emphasizes the roles of increasing perceived self-efficacy and distress tolerance. While self-efficacy and distress tolerance have separately been shown to predict OCD symptoms and treatment outcomes, no studies have assessed their joint effects in ERP. The current study examined distress tolerance as a mediator of the relationship between self-efficacy and ERP outcomes. METHODS Patients in an intensive ERP-based treatment program (N = 116) completed weekly self-report measures. RESULTS Over the course of treatment, as OCD symptoms reduced, self-efficacy and distress tolerance both significantly increased. Importantly, increases in self-efficacy and distress tolerance mediated each other in explaining symptom reduction, suggesting a possible bi-directional effect. LIMITATIONS The temporal relationship between changes in self-efficacy and distress tolerance is worthy of further investigation. In addition, the current sample had limited racial diversity and might not be representative of patients receiving lower levels of care. Findings merit replication to be ascertained of their reliability. CONCLUSIONS Findings suggest that during ERP, patients gain confidence in their abilities both to cope with general challenges and to withstand distress, potentially helping them engage with exposures and overcome initial fears. These findings provide support for the inhibitory learning model and highlight the mechanistic roles of self-efficacy and distress tolerance in ERP. Clinical implications to target both in treatment are discussed.
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Affiliation(s)
- Junjia Xu
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America; Harvard Medical School, United States of America
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America; Harvard Medical School, United States of America.
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Walker DM, Hefner JL, MacEwan SR, Di Tosto G, Sova LN, Gaughan AA, Huerta TR, McAlearney AS. Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e245091. [PMID: 38573634 PMCID: PMC11192182 DOI: 10.1001/jamanetworkopen.2024.5091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/06/2024] [Indexed: 04/05/2024] Open
Abstract
Importance Differences in patient use of health information technologies by race can adversely impact equitable access to health care services. While this digital divide is well documented, there is limited evidence of how health care systems have used interventions to narrow the gap. Objective To compare differences in the effectiveness of patient training and portal functionality interventions implemented to increase portal use among racial groups. Design, Setting, and Participants This secondary analysis used data from a randomized clinical trial conducted from December 15, 2016, to August 31, 2019. Data were from a single health care system and included 6 noncancer hospitals. Participants were patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay. Data were analyzed from September 1, 2022, to October 31, 2023. Interventions A 2 × 2 factorial design was used to compare the inpatient portal training intervention (touch, in-person [high] vs built-in video tutorial [low]) and the portal functionality intervention (technology, full functionality [full] vs a limited subset of functions [lite]). Main Outcomes and Measures Primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and use of specific portal functions. A logistic regression model was used to test the association of the estimators with the comprehensiveness use measure. Outcomes are reported as incidence rate ratios (IRRs) for the frequency outcomes or odds ratios (ORs) for the comprehensiveness outcomes with corresponding 95% CIs. Results Of 2892 participants, 550 (19.0%) were Black individuals, 2221 (76.8%) were White individuals, and 121 (4.2%) were categorized as other race (including African, American Indian or Alaska Native, Asian or Asian American, multiple races or ethnicities, and unknown race or ethnicity). Black participants had a significantly lower frequency (IRR, 0.80 [95% CI, 0.72-0.89]) of inpatient portal use compared with White participants. Interaction effects were not observed between technology, touch, and race. Among participants who received the full technology intervention, Black participants had lower odds of being comprehensive users (OR, 0.76 [95% CI, 0.62-0.91), but interaction effects were not observed between touch and race. Conclusions and Relevance In this study, providing in-person training or robust portal functionality did not narrow the divide between Black participants and White participants with respect to their inpatient portal use. Health systems looking to narrow the digital divide may need to consider intentional interventions that address underlying issues contributing to this inequity. Trial Registration ClinicalTrials.gov Identifier: NCT02943109.
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Affiliation(s)
- Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Jennifer L. Hefner
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Sarah R. MacEwan
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus
| | - Gennaro Di Tosto
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Lindsey N. Sova
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Alice A. Gaughan
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Timothy R. Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
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Zapata MA, Worrell FC. Disability Acceptance and Affirmation Among U.S. Adults With Learning Disabilities and ADHD. JOURNAL OF LEARNING DISABILITIES 2024; 57:79-90. [PMID: 37489284 PMCID: PMC10935616 DOI: 10.1177/00222194231186665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Personal disability identity is a predictor of psychosocial functioning among adults with predominantly physical disabilities. In the present study, we examined personal disability identity in adults with learning disabilities (LD) and/or attention-deficit/hyperactivity disorder (ADHD). In samples of 541 adults with LD, 475 with ADHD, and 433 with comorbid LD and ADHD, we examined the structural validity of disability acceptance and disability affirmation scores and the association between these scores and anxiety/depression, life satisfaction, and general self-efficacy. Factor analyses supported a 4-item disability acceptance and 3-item disability affirmation scale in LD-only and ADHD-only samples. Among adults with LD or ADHD, disability affirmation was a meaningful predictor of life satisfaction, and disability acceptance predicted general self-efficacy. Disability identity attitudes are worthy of clinical and scholarly attention in adults with LD and ADHD, and adults with comorbid LD and ADHD may warrant special consideration in the personal disability identity literature.
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Nair D, Schildcrout JS, Shi Y, Trochez R, Nwosu S, Bell SP, Mixon AS, Welch SA, Goggins K, Bachmann JM, Vasilevskis EE, Cavanaugh KL, Rothman RL, Kripalani SB. Patient-reported predictors of post-discharge mortality after cardiac hospitalization. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.02.23296460. [PMID: 37873096 PMCID: PMC10593012 DOI: 10.1101/2023.10.02.23296460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Adults hospitalized for cardiovascular events are at high risk for post-discharge mortality. Hospital-based screening of health-related psychosocial risk factors is now prioritized by the Joint Commission and the National Quality Forum to achieve equitable, high-quality care. We tested our hypothesis that key patient-reported psychosocial and behavioral measures could predict post-hospitalization mortality in a cohort of adults hospitalized for a cardiovascular event. Methods This was a prospective cohort of adults hospitalized at Vanderbilt University Medical Center. Validated patient-reported measures of health literacy, social support, disease self-management, and socioeconomic status were used as predictors of interest. Cox survival analyses of mortality were conducted over a median 3.5-year follow-up (range: 1.25 - 5.5 years). Results Among 2,977 adults, 1,874 (63%) were hospitalized for acute coronary syndrome and 1,103 (37%) were hospitalized for acute decompensated heart failure; 60% were male; and the mean age was 53 years. After adjusting for demographic, clinical, and other psychosocial factors, mortality risk was greatest among patients who reported being unable to work due to disability (Hazard Ratio (HR) 2.36, 95% Confidence Interval (CI): 1.73-3.21), who were retired (HR 2.14, 95% CI 1.60-2.87), and who reported unemployment (HR 1.99, 95% CI 1.30-3.06) as compared to those who were employed. Patient-reported measures of disease self-management, perceived health competence and exercise frequency, were also associated with mortality risk after full covariate adjustment (HR 0.86, 95% CI 0.73-1.00 per four-point increase), (HR 0.86, 95% CI 0.77-0.96 per three-day change), respectively. Conclusions Patient-reported measures of employment status independently predict post-discharge mortality after a cardiac hospitalization. Measure of disease self-management also have prognostic modest utility. Hospital-based screening of psychosocial risk is increasingly prioritized in legislative policy. Incorporating brief, valid measures of employment status and disease self-management factors may help target patients for psychosocial, financial, and rehabilitative resources during post-discharge transitions of care.
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Aderibigbe T, Walsh S, Henderson WA, Lucas RF. Psychometric testing of the breastfeeding self-efficacy scale to measure exclusive breastfeeding in African American women: a cross-sectional study. Front Public Health 2023; 11:1196510. [PMID: 37822543 PMCID: PMC10563511 DOI: 10.3389/fpubh.2023.1196510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Background In United States, African American women are the least likely group to breastfeed exclusively compared with Hispanic and non-Hispanic white women. It is crucial to examine the perceived confidence of African American women towards practicing exclusive breastfeeding. Previous studies have examined breastfeeding self-efficacy and other factors influencing exclusive breastfeeding. However, there is no research on exclusive breastfeeding self-efficacy of this population. The purpose of this study was to examine the validity and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding, and the relationship between exclusive breastfeeding self-efficacy and general self-efficacy and demographic variables in African American women. Methods Descriptive cross-sectional design was used. A convenience sample of 53 pregnant African American women completed an online survey. Construct and criterion-related validity were assessed and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding (BSES-EBF) was examined using Cronbach's reliability. The general self-efficacy scale measured general self-efficacy. Descriptive statistics, bivariate correlation and non-parametric analyses were performed using statistical package for social sciences (v.28). Results The breastfeeding self-efficacy to measure exclusive breastfeeding scale had a Cronbach's alpha score of 0.907. One principal component was extracted from the BSES-EBF scale, with an Eigenvalue of 5.271 and which explained 58.57% of the variance in the instrument. The mean prenatal exclusive breastfeeding self-efficacy of participants was 35.15 (±7.41) from a range of 9 to 45. Exclusive breastfeeding was significantly associated with general self-efficacy (r = 0.503, p ≤ 0.001) and exclusive breastfeeding intention (p = 0.034). Conclusion Breastfeeding self-efficacy scale to measure exclusive breastfeeding is a valid and reliable tool to measure exclusive breastfeeding self-efficacy in African American women. African American women had high exclusive breastfeeding self-efficacy (internal motivation). Hence, there is a need to address breastfeeding barriers and provide access to culturally sensitive support (external motivation) to increase exclusive breastfeeding in African American women.
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Affiliation(s)
- Tumilara Aderibigbe
- School of Nursing, University of Connecticut, Storrs, CT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Stephen Walsh
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Wendy A. Henderson
- School of Nursing, University of Connecticut, Storrs, CT, United States
- School of Medicine, University of Connecticut, Storrs, CT, United States
| | - Ruth F. Lucas
- School of Nursing, University of Connecticut, Storrs, CT, United States
- School of Medicine, University of Connecticut, Storrs, CT, United States
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Adinkrah E, Najand B, Young-Brinn A, Salimi S. Association between School Achievement and Tobacco Susceptibility among US Adolescents: Ethnic Differences. CHILDREN (BASEL, SWITZERLAND) 2023; 10:327. [PMID: 36832456 PMCID: PMC9955712 DOI: 10.3390/children10020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Although risky behaviors such as educational problems and tobacco use tend to co-occur, these associations may vary across diverse ethnic groups, in part because ethnic minorities tend to reside in worse neighborhoods and tend to attend worse schools than Non-Latino White adolescents. AIM To compare the association between baseline school achievement (student grades) and subsequent tobacco use susceptibility (openness to smoke in future) by ethnicity, we compared African American, Latino, and Non-Latino White adolescents in the US over a four-year period. METHODS This longitudinal study followed 3636 adolescents who were never smokers at baseline for a period of four years. Baseline and four-year data of the Population Assessment of Tobacco and Health (PATH) study were used for this analysis. All participants were 12 to 17 years old at baseline and were either Non-Latino White (Majority), African American (Minority), or Latino (Minority). The outcome was a tobacco use susceptibility score at wave 4 which was defined as openness to use tobacco in the future, measured at year four. The predictor was school achievement at wave 1, measured as grades from F to A+. The moderator was ethnicity (African American, Latino, Non-Latino White), and covariates were age, gender, parental education, and family structure. RESULTS Our linear regressions in the pooled sample showed an inverse association between baseline school achievement and subsequent tobacco use susceptibility four years later. However, this inverse association was weaker for ethnic minorities than for Non-Latino White adolescents, as documented by interaction effects between ethnic minority status and baseline school grades. CONCLUSION Higher educational success better correlates with lower tobacco use susceptibility of non-Latino White than African American and Latino adolescents, which may reflect some tobacco use susceptibility of Latino and African American adolescents with highly educated parents. Future research should investigate how social context such as high-risk school environment, neighborhood risk, peer risk, and other mechanisms increase behavioral risk of educationally successful African American and Latino adolescents.
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Affiliation(s)
- Edward Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns, Los Angeles, CA 90059, USA
| | - Babak Najand
- Marginalization-Related Diminished Returns, Los Angeles, CA 90059, USA
| | - Angela Young-Brinn
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
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Adinkrah E, Najand B, Young-Brinn A. Parental Education and Adolescents' Asthma: The Role of Ethnicity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020267. [PMID: 36832395 PMCID: PMC9955909 DOI: 10.3390/children10020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
While high parental education is associated with better health, this association may be weaker for ethnic minority than for ethnic majority families. It is unknown whether the association between parental education and adolescents' asthma also varies by ethnicity. AIM To study the association between parental education and adolescents' asthma overall and by ethnicity. METHODS The current study used data from the Population Assessment of Tobacco and Health (PATH)-Adolescents study. All participants were 12 to 17-year-old non-smokers (n = 8652). The outcome of interest was adolescents' asthma. The predictor of interest was baseline parental education, the covariates were age, sex, and number of parents present at baseline, and the moderator was ethnicity. RESULTS According to logistic regression analyses, higher parental education was predictive of adolescents' asthma; however, this association was weaker for Latino than non-Latino adolescents (OR 1.771; CI 1.282-2.446). We did not find a significant difference in the effect of parental education on asthma of White and African American adolescents. Our stratified models also showed that higher parental education was associated with lower asthma for non-Latino but not for Latino adolescents. CONCLUSION The effect of high parental education on adolescents' asthma prevalence differs between Latino and non-Latino families, with Latino families showing weaker protective effects of parental education on adolescents' asthma. Future research should test the role of exposure to environmental pollutants, neighborhood quality, and prevalence of smoking in social network members as well as other contextual factors at home, in school, and in the neighborhood that may increase prevalence of asthma in Latino adolescents regardless of their parental education. Given that these potential causes are multi-level, potential causes of such disparities should be tested in future multi-level research.
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Affiliation(s)
- Edward Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA
- Correspondence:
| | - Babak Najand
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Angela Young-Brinn
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA
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Adinkrah E, Najand B, Young-Brinn A. Race and Ethnic Differences in the Protective Effect of Parental Educational Attainment on Subsequent Perceived Tobacco Norms among US Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2517. [PMID: 36767881 PMCID: PMC9916299 DOI: 10.3390/ijerph20032517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/10/2022] [Accepted: 12/27/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although parental educational attainment is known to be associated with a lower prevalence of behaviors such as tobacco use, these effects are shown to be weaker for Black than White youth. It is important to study whether this difference is due to higher perceived tobacco use norms for Black youth. AIM To study the association between parental educational attainment and perceived tobacco use norms overall and by race/ethnicity among youth in the US. METHODS The current study used four years of follow-up data from the Population Assessment of Tobacco and Health (PATH-Youth) study conducted between 2013 and 2017. All participants were 12- to 17-year-old non-smokers at baseline and were successfully followed for four years (n = 4329). The outcome of interest was perceived tobacco use norms risk at year four. The predictor of interest was baseline parental educational attainment, the moderator was race/ethnicity, and the covariates were age, sex, and parental marital status at baseline. RESULTS Our linear regressions in the pooled sample showed that higher parental educational attainment at baseline was predictive of perceived disapproval of tobacco use at year four; however, this association was weaker for Latino than non-Latino youth. Our stratified models also showed that higher parental educational attainment was associated with perceived tobacco use norms for non-Latino but not for Latino youth. CONCLUSION The effect of high parental educational attainment on anti-tobacco norms differs between Latino and non-Latino youth. Latino youth with highly educated parents remain at risk of tobacco use, while non-Latino youth with highly educated parents show low susceptibility to tobacco use.
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Affiliation(s)
- Edward Adinkrah
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Babak Najand
- Marginalization-Related Diminished Returns, Los Angeles, CA 90059, USA
| | - Angela Young-Brinn
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns, Los Angeles, CA 90059, USA
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Cheng P, Casement MD, Kalmbach DA, Cuamatzi Castelan A, Drake CL. Self-efficacy in Insomnia Symptom Management after Digital CBT-I Mediates Insomnia Severity during the COVID-19 Pandemic. Behav Sleep Med 2022; 20:638-648. [PMID: 34511016 PMCID: PMC8917241 DOI: 10.1080/15402002.2021.1976780] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVES Digital cognitive behavioral therapy for insomnia (dCBT-I) can reduce acute insomnia and depressive symptoms and prevent symptom recurrence. The current study evaluated self-efficacy in managing insomnia symptoms as a potential mediator of the relationship between prior dCBT-I and subsequent insomnia and depressive symptoms assessed during the coronavirus 2019 (COVID-19) pandemic. METHOD Participants were 208 adults who completed a randomized controlled trial of dCBT-I versus sleep education in 2016-2017 and also completed self-report assessments of insomnia, depression, and self-efficacy in managing insomnia symptoms. Data were collected in May 2020, five weeks into state-wide COVID-19 stay-at-home orders. Regression and mediation analyses were used to evaluate the extent to which self-efficacy accounted for the relationship between treatment condition and improvement in insomnia and depressive symptoms from pre-treatment to COVID-19 follow-up. RESULTS Prior dCBT-I predicted greater self-efficacy in managing insomnia symptoms. Self-efficacy accounted for 49% and 67% of the protective effect of dCBT-I against COVID-era insomnia and depressive symptoms, respectively. CONCLUSIONS This study affirms the importance of self-efficacy as a key intervention outcome and potential mechanism by which dCBT-I predicts future sleep and mental health. Future studies that evaluate the role of self-efficacy in treatment effectiveness and resilience can provide additional clues about how to optimize dCBT-I for maximum benefit to public health.
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Affiliation(s)
- Philip Cheng
- Sleep Disorders and Research Center, Henry Ford Health
System, 2779 West Grant Blvd, Detroit, MI, USA
| | - Melynda D. Casement
- Department of Psychology, University of Oregon, 1451 Onyx
Street, Eugene, OR 97403 USA
| | - David A. Kalmbach
- Sleep Disorders and Research Center, Henry Ford Health
System, 2779 West Grant Blvd, Detroit, MI, USA
| | - Andrea Cuamatzi Castelan
- Sleep Disorders and Research Center, Henry Ford Health
System, 2779 West Grant Blvd, Detroit, MI, USA
| | - Christopher L. Drake
- Sleep Disorders and Research Center, Henry Ford Health
System, 2779 West Grant Blvd, Detroit, MI, USA
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12
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Dolatabadi S, Bohlouli B, Amin M. Associations between Perceived Self-Efficacy and Oral Health Behaviours in Adolescents. Int J Dent Hyg 2022; 20:593-600. [PMID: 35920241 DOI: 10.1111/idh.12610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/23/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Self-efficacy is a strong health predictor as it affects patients' certainty about their ability to perform recommended behaviours to improve their health. The aim of this study was to examine the associations between perceived self-efficacy and oral health behaviours among adolescents. METHODS A convenience sample of adolescents aged 12 to 18 years old were recruited from University of Alberta dental clinic. Demographics, oral health behaviours, self-rated oral health, and task-specific and general self-efficacy were assessed using a questionnaire with three sections. For the comparisons of outcomes across different categories, Student t-test, multivariate regression, and chi-squared tests were used. RESULTS Total of 252 adolescents with average (SD) age of 14 (1.7) years participated in the study; 60% were girls; 81% were born in Canada; 56% were White; and 61% had dental coverage. Demographic characteristics had no significant correlation with general self-efficacy. However, correlation coefficients indicated that younger adolescents had higher dietary self-efficacy (negative correlation), girls had higher toothbrushing and dental visit self-efficacy, and those with dental coverage had higher dental visit self-efficacy. A significant association was found between toothbrushing, dietary habits, and dental visits self-efficacy (subscales of task-specific self-efficacy) and their respective outcomes (frequency of toothbrushing, sugar-intake, and regular dentist visits). General self-efficacy was significantly associated with frequency of toothbrushing and participant's self-rated oral health. CONCLUSION Higher task-specific and general self-efficacy correlated with better oral health behaviours among adolescents. Therefore, behavioural interventions should be designed to enhance self-efficacy among adolescents in order to improve their oral health outcomes.
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Affiliation(s)
- Samin Dolatabadi
- Department of Biological Sciences, University of Alberta, Edmonton, Canada
| | - Babak Bohlouli
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
| | - Maryam Amin
- Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada
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13
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Underlying Factors of Health Insurance Use Among Blacks and Hispanics With Ambulatory Care-Sensitive Conditions. J Ambul Care Manage 2022; 45:114-125. [PMID: 35202028 DOI: 10.1097/jac.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined satisfaction with and confidence in understanding health insurance use among Blacks and Hispanic Americans with ambulatory care-sensitive conditions. Using the 2013-2016 Health Reform Monitoring Survey data sets, descriptive statistics and ordinary least-square regressions estimated the association between satisfaction and confidence scores and racial or ethnic groups with ambulatory care-sensitive conditions. Compared with their White counterparts, Black (β = -.13; 95% confidence interval [CI], -0.19 to -0.06) and Hispanic (β = -0.41; 95% CI, -0.48 to -0.33) participants' standardized confidence scores were significantly lower. Research is needed to identify factors that may enhance this population's confidence level.
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14
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Pappalardo AA, Herbert L, Warren C, Lombard L, Ramos A, Asa’ad A, Sharma H, Tobin MC, Choi J, Hultquist H, Jiang J, Kulkarni A, Mahdavinia M, Vincent E, Gupta R. Self-Efficacy Among Caregivers of Children With Food Allergy: A Cohort Study. J Pediatr Psychol 2022; 47:674-684. [PMID: 35079803 PMCID: PMC9425846 DOI: 10.1093/jpepsy/jsab137] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/20/2023] Open
Abstract
Abstract
Objective
The prevalence of pediatric food allergy (FA) is increasing and, due to early disease onset, requires significant caregiver management that is associated with psychosocial burden. Caregiver perception of how they cope and handle FA-related events (self-efficacy) has been linked to psychosocial outcomes in racially/geographically homogenous samples. This study explores FA-related caregiver self-efficacy and associations with FA-related caregiver quality of life (QoL) in a diverse cohort.
Methods
Caregivers of children, diagnosed with IgE-mediated FA who identified as non-Hispanic Black or White, were recruited from U.S. academic allergy clinics. Caregivers completed demographic and medical questionnaires, the Food Allergy Self-Efficacy Scale for Parents (FASE-P), Food Allergy Independent Measure—Parent Form (FAIM), and the Food Allergy Quality of Life—Parental Burden (FAQL-PB). Bivariate and multivariate associations estimated relationships between study variables.
Results
Caregivers of 365 children (Mage = 5.8 years, 62.2% male, 31.1% Black) were enrolled. Caregivers reported high FA self-efficacy (M = 82.06/100), moderate perceptions of risk/FA severity (FAIM: M = 3.9/7), and some limitations on the FAQL-PB (M = 3.9/7). Self-efficacy was related to lower perceptions of risk/FA severity across all demographic groups (r = −.42, p < .001). Caregivers who reported higher self-efficacy reported better QoL, particularly Black caregivers (r = .67).
Conclusions
In this sample of caregivers of children with FA, greater self-efficacy was related to improved QoL regardless of sociodemographic factors. Caregivers’ perception of risk was lower for those with greater self-efficacy. Future research into the impact of FA management on QoL among diverse caregivers is needed.
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Affiliation(s)
| | - Linda Herbert
- Children’s National Hospital, USA
- George Washington University School of Medicine, USA
| | - Christopher Warren
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
| | - Lisa Lombard
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
| | - Ashley Ramos
- Children’s National Hospital, USA
- George Washington University School of Medicine, USA
| | - Amal Asa’ad
- Cincinnati Children’s Hospital Medical Center, USA
| | - Hemant Sharma
- Children’s National Hospital, USA
- George Washington University School of Medicine, USA
| | | | - Jonathan Choi
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Haley Hultquist
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Jialing Jiang
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Ashwin Kulkarni
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | | | - Eileen Vincent
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Ruchi Gupta
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
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15
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Hladek MD, Zhu J, Buta BJ, Szanton SL, Bandeen-Roche K, Walston JD, Xue QL. Self-efficacy proxy predicts frailty incidence over time in non-institutionalized older adults. J Am Geriatr Soc 2021; 69:3507-3518. [PMID: 34418062 PMCID: PMC8648965 DOI: 10.1111/jgs.17417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Physical frailty is defined as a syndrome of decreased physiologic reserve conferring vulnerability to functional decline, mortality, and other adverse outcomes upon experiencing stressors. Self-efficacy, which is confidence in one's ability to perform well in a domain of life, is modifiable. Self-efficacy is associated with improved health behavior and decreased chronic disease burden. Its relationship to frailty is unknown. The purpose of this study was to evaluate whether a general self-efficacy proxy predicts incident frailty. METHODS A nationally representative sample of 4825 U.S. older adults aged 65 and older living in the community or non-nursing home care setting enrolled in the National Health and Aging Trends Study from 2011 to 2018 was used. Self-efficacy was dichotomized into low and high groups using the one-item self-efficacy proxy measure. The Physical Frailty Phenotype was used to categorize participants as frail and non-frail. A discrete time hazard model using data from eight rounds was used to obtain incident hazard ratios of frailty in two models. Model 1 was adjusted for age, race, sex, education, and income. Model 2 contained Model 1 covariates and added disability and comorbidities. RESULTS Among people without frailty at baseline, risk of developing frailty over 7 years was increased by 41% among those with low versus high self-efficacy after adjustment for sociodemographics (P = 0.002), and by 27% after further adjustment for disability and comorbidities (P = 0.032). CONCLUSION This study generates a rationale to further explore self-efficacy in frailty research. Self-efficacy may be a key modifiable element to incorporate into multimodal physical frailty interventions.
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Affiliation(s)
| | - Jiafeng Zhu
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Brian J. Buta
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | - Karen Bandeen-Roche
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jeremy D. Walston
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
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16
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Louie P, Upenieks L, Siddiqi A, Williams DR, Takeuchi DT. Race, Flourishing, and All-Cause Mortality in the United States, 1995-2016. Am J Epidemiol 2021; 190:1735-1743. [PMID: 33728457 DOI: 10.1093/aje/kwab067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/12/2022] Open
Abstract
We assessed whether race moderates the association between flourishing and all-cause mortality. We used panel data from the Midlife in the United States Study (MIDUS) (1995-2016; n = 2,851). Approximately 19% of White respondents and 23% of Black respondents in the baseline sample died over the course of the 21-year study period (n = 564). Cox proportional hazard models showed that Blacks had a higher mortality rate relative to Whites and higher levels of flourishing were associated with a lower mortality rate. Furthermore, a significant interaction between flourishing and race in predicting death was observed. Blacks with higher levels of flourishing had a mortality rate that was not significantly different from that of Whites. However, Blacks, but not Whites, with low flourishing scores had a higher mortality rate. As such, health-promotion efforts focused on enhancing flourishing among Black populations may reduce the Black-White gap in mortalityrate.
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17
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Sun K, Eudy AM, Criscione-Schreiber LG, Sadun RE, Rogers JL, Doss J, Corneli AL, Bosworth HB, Clowse MEB. Racial Differences in Patient-provider Communication, Patient Self-efficacy, and Their Associations With Systemic Lupus Erythematosus-related Damage: A Cross-sectional Survey. J Rheumatol 2021; 48:1022-1028. [PMID: 33259332 PMCID: PMC10698393 DOI: 10.3899/jrheum.200682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Despite significant racial disparities in systemic lupus erythematosus (SLE) outcomes, few studies have examined how disparities may be perpetuated in clinical encounters. We aimed to explore associations between areas of clinical encounters - patient-provider communication and patient self-efficacy - with SLE-related damage, in order to identify potential areas for intervention to reduce SLE outcome disparities. METHODS We collected cross-sectional data from a tertiary SLE clinic including patient-provider communication, general self-efficacy, self-efficacy for managing medications and treatments, patient-reported health status, and clinical information. We compared racial groups and used logistic regression to assess race-stratified association of patient-provider communication and patient self-efficacy with having SLE-related damage. RESULTS Among 121 patients (37% White, 63% African American), African Americans were younger, more likely to be on Medicaid, and less likely to be college educated, married, or living with a partner or spouse. African Americans reported less fatigue and better social function, took more complex SLE medication regimens, had lower fibromyalgia (FM) scores, and had higher SLE disease activity and SLE-related damage scores. African Americans reported similar self-efficacy compared to White patients, but they reported more hurried communication with providers, which was reflected in their perception that providers used words that were difficult to understand. Perceiving providers use difficult words and lower general self-efficacy were associated with having SLE-related damage among African American but not White patients. CONCLUSION African Americans had more severe SLE and perceived more hurried communication with providers. Both worse communication and lower self-efficacy were associated with having SLE-related damage among African American but not White patients, suggesting that these factors should be investigated as potential interventions to reduce SLE racial disparities.
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Affiliation(s)
- Kai Sun
- K. Sun, MD, MS, Assistant Professor, A.E. Eudy, PhD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Associate Professor, R.E. Sadun, MD, PhD, Assistant Professor, J.L. Rogers, MD, Assistant Professor, J. Doss, MD, MPH, Assistant Professor, M.E. Clowse, Associate Professor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine;
| | - Amanda M Eudy
- K. Sun, MD, MS, Assistant Professor, A.E. Eudy, PhD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Associate Professor, R.E. Sadun, MD, PhD, Assistant Professor, J.L. Rogers, MD, Assistant Professor, J. Doss, MD, MPH, Assistant Professor, M.E. Clowse, Associate Professor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine
| | - Lisa G Criscione-Schreiber
- K. Sun, MD, MS, Assistant Professor, A.E. Eudy, PhD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Associate Professor, R.E. Sadun, MD, PhD, Assistant Professor, J.L. Rogers, MD, Assistant Professor, J. Doss, MD, MPH, Assistant Professor, M.E. Clowse, Associate Professor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine
| | - Rebecca E Sadun
- K. Sun, MD, MS, Assistant Professor, A.E. Eudy, PhD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Associate Professor, R.E. Sadun, MD, PhD, Assistant Professor, J.L. Rogers, MD, Assistant Professor, J. Doss, MD, MPH, Assistant Professor, M.E. Clowse, Associate Professor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine
| | - Jennifer L Rogers
- K. Sun, MD, MS, Assistant Professor, A.E. Eudy, PhD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Associate Professor, R.E. Sadun, MD, PhD, Assistant Professor, J.L. Rogers, MD, Assistant Professor, J. Doss, MD, MPH, Assistant Professor, M.E. Clowse, Associate Professor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine
| | - Jayanth Doss
- K. Sun, MD, MS, Assistant Professor, A.E. Eudy, PhD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Associate Professor, R.E. Sadun, MD, PhD, Assistant Professor, J.L. Rogers, MD, Assistant Professor, J. Doss, MD, MPH, Assistant Professor, M.E. Clowse, Associate Professor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine
| | - Amy L Corneli
- A.L. Corneli, PhD, Associate Professor, H.B. Bosworth, PhD, Professor, Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hayden B Bosworth
- A.L. Corneli, PhD, Associate Professor, H.B. Bosworth, PhD, Professor, Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan E B Clowse
- K. Sun, MD, MS, Assistant Professor, A.E. Eudy, PhD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Associate Professor, R.E. Sadun, MD, PhD, Assistant Professor, J.L. Rogers, MD, Assistant Professor, J. Doss, MD, MPH, Assistant Professor, M.E. Clowse, Associate Professor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine
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18
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Long Q, Guo J, Zhong Q, Jiang S, Wiley J, Chen JL. General self-efficacy and social support as mediators of the association between perceived stress and quality of life among rural women with previous gestational diabetes mellitus. J Clin Nurs 2021; 30:1026-1036. [PMID: 33434309 DOI: 10.1111/jocn.15648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 11/17/2020] [Accepted: 12/31/2020] [Indexed: 11/27/2022]
Abstract
To explore the association between perceived stress and quality of life (QoL) and the mediating role of general self-efficacy and social support in this association. Gestational diabetes mellitus (GDM) is one of the most common metabolic diseases suffered by pregnant women. Women with previous GDM may experience more medical-related stress and have a lower QoL than those without it. A multisite correlational study. Four hundred sixty-five women with previous GDM living in rural areas in China participated in this study from November 2017 to June 2019. The participants completed a set of self-reported socio-demographic questionnaires, the Perceived Stress Scale, the General Self-Efficacy Scale, the Social Support Rating Scale and the World Health Organization QoL assessment (Brief version). STROBE checklist was used as the guideline for this study. The mean QoL score was 13.97 (SD 2.07) for physical health, 13.75 (SD 1.98) for psychological health, 14.96 (SD 1.99) for social relations and 12.49 (SD 1.74) for environmental conditions. About 43.9% of women with previous GDM reported increased stress, which was negatively correlated with each of these QoL domains. Yet, the negative effect of perceived stress on QoL could be completely or partly mediated by better social support or general self-efficacy among this population. Nearly half of the women in the study living in rural China reported increased stress after delivery, and there is room to improve QoL in the environmental domain among women with previous GDM. Increasing general self-efficacy or social support can help these women avoid the negative effects of perceived stress on their QoL. These findings suggest that healthcare providers need to be cognizant of the importance of self-efficacy and social support for women with previous GDM in both enhancing QoL and reducing the negative impact of perceived stress on QoL.
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Affiliation(s)
- Qing Long
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Qinyi Zhong
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Shan Jiang
- Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - James Wiley
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Jyu-Lin Chen
- School of Nursing, University of California, San Francisco, CA, USA
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19
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Assari S, Malek-Ahmadi MR, Caldwell CH. Parental Education or Household Income? Which Socioeconomic Status Indicator Can Better Reduce Body Mass Index Disparities among Latino Children? ACTA ACUST UNITED AC 2020; 7:19-37. [PMID: 34307868 DOI: 10.22158/jepf.v7n1p19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aim We compared the effects of parental education and household income on children's body mass index (BMI) in Hispanic White (HW) and non-Hispanic White (NHW) families. Methods In this cross-sectional study, we borrowed data from the Adolescent Brain Cognitive Development (ABCD) study and analyzed data of 5100 children between the ages of 9 and 10. The independent variables were parental education and household income. The primary outcome was BMI value. Ethnicity was the moderating variable. Confounders were age, sex, and family structure. Three mixed-effects regression models were used for data analysis. Results Overall, higher parental education and household income were associated with lower BMI levels in children. While an interaction was found between ethnicity and parental education, no interaction was noted between ethnicity and household income regarding BMI. The interaction indicated weaker protective effects of high parental education on BMI in HW children than NHW children. Household income showed similar protective effects on children's BMI in HW and NHW families. Conclusion Parental education but not household income loses some of its protective effects on childhood BMI among HW families compared to NHW families. Distal social determinants of health may be more vulnerable to the MDRs (minorities' diminished returns) than proximal ones. As a result, closing the income gap may be a good strategy towards closing the childhood BMI gap between highly educated HW and NHW families. Policies that raise the minimum wage and those that help HW families save money (e.g., earned income tax policies) maybe more promising strategies to eliminate the ethnic gap in BMI than increasing the education level of ethnic minority families.
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Affiliation(s)
- Shervin Assari
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.,Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Cleopatra H Caldwell
- Department of Health Behaviors and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI, USA
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20
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Parental Education, Household Income, Race, and Children's Working Memory: Complexity of the Effects. Brain Sci 2020; 10:brainsci10120950. [PMID: 33297546 PMCID: PMC7762416 DOI: 10.3390/brainsci10120950] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/01/2020] [Accepted: 12/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background. Considerable research has linked social determinants of health (SDoHs) such as race, parental education, and household income to school performance, and these effects may be in part due to working memory. However, a growing literature shows that these effects may be complex: while the effects of parental education may be diminished for Blacks than Whites, household income may explain such effects. Purpose. Considering race as sociological rather than a biological construct (race as a proxy of racism) and built on Minorities' Diminished Returns (MDRs), this study explored complexities of the effects of SDoHs on children's working memory. Methods. We borrowed data from the Adolescent Brain Cognitive Development (ABCD) study. The total sample was 10,418, 9- and 10-year-old children. The independent variables were race, parental education, and household income. The primary outcome was working memory measured by the NIH Toolbox Card Sorting Test. Age, sex, ethnicity, and parental marital status were the covariates. To analyze the data, we used mixed-effect regression models. Results. High parental education and household income were associated with higher and Black race was associated with lower working memory. The association between high parental education but not household income was less pronounced for Black than White children. This differential effect of parental education on working memory was explained by household income. Conclusions. For American children, parental education generates unequal working memory, depending on race. This means parental education loses some of its expected effects for Black families. It also suggests that while White children with highly educated parents have the highest working memory, Black children report lower working memory, regardless of their parental education. This inequality is mainly because of differential income in highly educated White and Black families. This finding has significant public policy and economic implications and suggests we need to do far more than equalizing education to eliminate racial inequalities in children's cognitive outcomes. While there is a need for multilevel policies that reduce the effect of racism and social stratification for middle-class Black families, equalizing income may have more returns than equalizing education.
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21
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Assari S. Mental Rotation in American Children: Diminished Returns of Parental Education in Black Families. Pediatr Rep 2020; 12:130-141. [PMID: 33233814 PMCID: PMC7717656 DOI: 10.3390/pediatric12030028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 01/07/2023] Open
Abstract
Background: While parental education and family socioeconomic status (SES) are associated with an increase in children's cognitive functioning, and less is known about racial variation in these effects. Minorities' Diminished Returns (MDRs) suggest that, under racism and social stratification, family SES and particularly parental education show weaker effects on children's tangible outcomes for marginalized, racialized, and minoritized families, particularly Blacks, compared to Whites. Aim: We conducted this study to compare the effect of parental education on children's mental rotation abilities, as an important aspect of cognitive function, by race. Methods: This cross-sectional study included 11,135 9-10-year-old American children. Data came from baseline of the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was parental education. The dependent variable, mental rotation, was measured by the Little Man Task. Ethnicity, gender, age, marital status, and household income were the covariates. Results: Parental education was positively associated with mental rotation. However, parental education showed a weaker association with mental rotation in Black than in White families. This was documented by a significant interaction between race and parental education on children's efficiency score. Conclusion: Parental education shows a weaker correlation with mental rotation of Black rather than White children, which is probably because of racism, social stratification, and discrimination. This finding is in line with the MDRs phenomenon and suggests that marginalization and racism may interfere with the influences of parental assets and resources and Black American children's development.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; ; Tel.: +1-734-232-0445; Fax: +1-734-615-8739
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
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22
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Assari S, Akhlaghipour G. Not Race or Age but Their Interaction Predicts Pre-Adolescents' Inhibitory Control. ACTA ACUST UNITED AC 2020; 3:50-71. [PMID: 33283174 DOI: 10.22158/ct.v3n2p50] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background African American pre-adolescents are at a higher risk of risky behaviors such as aggression, drug use, alcohol use, and subsequent poor outcomes compared to Caucasian pre-adolescents. All these high-risk behaviors are connected to low levels of inhibitory control (IC). Aim We used the Adolescent Brain Cognitive Development (ABCD) data to compare Caucasian and African American pre-adolescents for the effect of age on pre-adolescents IC, a driver of high-risk behaviors. Methods This cross-sectional analysis included 4,626 pre-adolescents between ages 9 and 10 from the ABCD study. Regression was used to analyze the data. The predictor variable was age measured in months. The main outcome was IC measured by a stop-signal task (SST). Race was the effect modifier. Results Overall, age was associated with IC. Race also showed a statistically significant interaction with age on pre-adolescents' IC, indicating weaker effects of age on IC for African American than Caucasian pre-adolescents. Conclusion Age-related changes in IC are more pronounced for Caucasian than African American pre-adolescents. To eliminate the racial gap in brain development between African American and Caucasian pre-adolescents, we should address structural and societal barriers that alter age-related development for racial minority pre-adolescents. Social and public policies, rather than health policies, are needed to address structural and societal barriers that hinder African American adolescents' brain development. Interventions should add resources to the urban areas that many African American families live in so their children can have better age-related brain development. Such changes would be essential given IC in pre-adolescents is a predictor of a wide range of behaviors.
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Affiliation(s)
- Shervin Assari
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA.,Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA
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Subjective Socioeconomic Status and Children's Amygdala Volume: Minorities' Diminish Returns. NEUROSCI 2020; 1:59-74. [PMID: 33103157 DOI: 10.3390/neurosci1020006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Considerable research has suggested that low socioeconomic status (SES) negatively influences brain structure, including but not limited to decreased amygdala volume. Considering race and ethnicity as sociological rather than biological constructs, this study was built on minorities' diminished returns (MDRs) to test if the effects of family SES on the total amygdala volume is weaker for black and Latino children than white and non-Latino children. We borrowed data from the Adolescent Brain Cognitive Development (ABCD) study, a national multi-center brain imaging investigation of childhood brain development in the US. The total sample was 9380 9-10-year-old children. The independent variables were subjective family SES and parental education. The primary outcome was total amygdala volume. High subjective SES and parental education were independently associated with larger total amygdala size. The association between high subjective SES and larger total amygdala volume was less pronounced for black and Latino children than white and non-Latino children. For American children, family SES has unequal effects on amygdala size and function, a pattern that is consistent with MDRs. This result suggests that SES loses some of its expected effects for racial and ethnic minority families.
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James D. Self- and group-focused internalized racism, anxiety, and depression symptoms among African American adults: A core self-evaluation mediated pathway. GROUP PROCESSES & INTERGROUP RELATIONS 2020. [DOI: 10.1177/1368430220942849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Internalized racism (IR) is a form of racism that leads people to internalize stereotypes about their racial/ethnic group (i.e., group-focused IR) and/or about themselves because of their racial/ethnic group membership (i.e., self-focused IR). However, although IR is associated with poor mental health, little is known about the underlying mechanisms of these associations. To address this limitation, this research investigates the core self-evaluation (CSE; a person’s fundamental evaluations about themselves, their own abilities, and their own control) mediated pathway as one potential pathway. CSE consists of four traits: self-esteem (SE), locus of control (LoC), emotional stability (ES), and generalized self-efficacy (GSE). With a sample of 780 Black/African American adults ( Mage = 37.68 years, % Female = 57.6), this study investigated the independent direct and indirect effects of group- and self-focused IR on depression and anxiety symptoms via CSE using structural equation modeling. Confirming predictions, self- and group-focused IR predicted greater anxiety and depression symptoms and lower SE and ES. However, against predictions, both forms of IR were associated with increased internal LoC and were not associated with GSE. Last, results show partial support for the CSE mediated pathway, such that SE and ES (but not LoC or GSE) mediated the relationship between both self- and group-focused IR and anxiety and depression symptoms. Results suggest that IR is indirectly related to mental health via the more affective (SE, ES) relative to motivational (LoC, GSE) components of CSE, which has implications for understanding underlying mechanisms associating IR with poor mental health among racial/ethnic minorities.
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Matthieu MM, Carbone JT. Collective action among US veterans: Understanding the importance of self-efficacy, collective efficacy, and social support. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1985-1996. [PMID: 32579741 DOI: 10.1002/jcop.22397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/28/2020] [Indexed: 06/11/2023]
Abstract
The purpose of this study was to examine the relationship between collective action, collective efficacy, self-efficacy, and social support among US veterans who formally volunteered in their communities upon their return from military service. The participants were 323 post-9/11/01-era veterans who completed a national nonprofit administered civic service program. Results from the structural equation model indicate that appraisal social support is negatively, directly associated with collective action, while belonging social support is positively, directly associated with collective action. In addition, appraisal social support is positively, indirectly associated with collective action via self-efficacy and collective efficacy. About 44% of the relationship between self-efficacy and collective action is associated via collective efficacy. The model accounts 19.9% of the variance in self-efficacy, 16.5% of the variance in collective efficacy, and 23.7% of the variance in collective action. The role of social support in the model provides additional evidence for the importance of strong social ties in facilitating collective action as veterans gather to volunteer in programs across the country. Results have implications for how national, nonprofit, and community volunteering programs may want to engage veterans and community members in collective action efforts.
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Affiliation(s)
- Monica M Matthieu
- College for Public Health and Social Justice, School of Social Work, Saint Louis University, Saint Louis, Missouri
| | - Jason T Carbone
- School of Social Work, Wayne State University, Detroit, Michigan
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Assari S, Akhlaghipour G, Boyce S, Bazargan M, Caldwell CH. African American Children's Diminished Returns of Subjective Family Socioeconomic Status on Fun Seeking. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E75. [PMID: 32660094 PMCID: PMC7401867 DOI: 10.3390/children7070075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/28/2020] [Accepted: 07/07/2020] [Indexed: 02/08/2023]
Abstract
Background: Reward sensitivity (fun-seeking) is a risk factor for a wide range of high-risk behaviors. While high socioeconomic status (SES) is known to reduce reward sensitivity and associated high-risk behaviors, less is known about the differential effects of SES on reward sensitivity. It is plausible to expect weaker protective effects of family SES on reward sensitivity in racial minorities, a pattern called Minorities' Diminished Returns (MDRs). Aim: We compared Caucasian and African American (AA) children for the effects of subjective family SES on children's fun-seeking. Methods: This was a cross-sectional analysis of 7061 children from the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was subjective family SES. The main outcome was children's fun-seeking measured by the behavioral approach system (BAS) and behavioral avoidance system (BIS). Age, gender, marital status, and household size were the covariates. Results: In the overall sample, high subjective family SES was associated with lower levels of fun-seeking. We also found a statistically significant interaction between race and subjective family SES on children's fun-seeking in the overall sample, suggesting that high subjective family SES is associated with a weaker effect on reducing fun-seeking among AA than Caucasian children. In race-stratified models, high subjective family SES was protective against fun-seeking of Caucasian but not AA children. Conclusion: Subjective family SES reduces the fun-seeking for Caucasian but not AA children.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Golnoush Akhlaghipour
- Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Shanika Boyce
- Department of Pediatrics, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Cleopatra H. Caldwell
- Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA;
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA
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Assari S, Boyce S, Bazargan M, Caldwell CH. African Americans' Diminished Returns of Parental Education on Adolescents' Depression and Suicide in the Adolescent Brain Cognitive Development (ABCD) Study. Eur J Investig Health Psychol Educ 2020; 10:656-668. [PMID: 32656052 PMCID: PMC7351357 DOI: 10.3390/ejihpe10020048] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To investigate racial and ethnic differences in the protective effects of parental education and marital status against adolescents' depressed mood and suicidal attempts in the U.S. As proposed by the Marginalization-related Diminished Returns (MDRs), parental education generates fewer tangible outcomes for non-White compared to White families. Our existing knowledge is very limited regarding diminished returns of parental education and marital status on adolescents' depressed mood and suicidal attempts. To compare racial groups for the effects of parental education and marital status on adolescents' depressed mood and suicidal attempt. This cross-sectional study included 7076 non-Hispanic White or African American 8-11 years old adolescents from the Adolescent Brain Cognitive Development (ABCD) study. The independent variables were parental education and marital status. The main outcomes were depressed mood and suicidal attempts based on parents' reports using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Age and gender were the covariates. Race was the moderator. Logistic regression was used to analyze the ABCD data. Overall, parental education was associated with lower odds of depressed mood (OR = 0.81; 95% CI = 0.67-0.99; p = 0.037) and having married parents was associated with lower odds of suicidal attempts (OR = 0.50; 95% CI = 0.28-0.91; p = 0.022). In the pooled sample, we found interaction terms between race with parental education and marital status on the outcomes, suggesting that the protective effect of having married parents against depressed mood (OR = 1.54; 95% CI = 1.00-2.37; p = 0.048) and the protective effect of having married parents against suicidal attempts (OR = 6.62; 95% CI = 2.21-19.86; p =0.001) are weaker for African Americans when compared to Whites. The protective effects of parent education and marital status against depressed mood and suicidal attempts are diminished for African American adolescents compared to White adolescents. There is a need for programs and interventions that equalize not only socioeconomic status (SES) but also the marginal returns of SES for racial minority groups. Such efforts require addressing structural and societal barriers that hinder African American families from translating their SES resources and human capital into tangible outcomes. There is a need for studies that can minimize MDRs for African American families, so that every individual and every family can benefit from their resources regardless of their skin color. To achieve such a goal, we need to help middle-class African American families secure tangible outcomes in the presence of SES resources.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
- Correspondence: ; Tel.: +1-734-232-0445; Fax: +1-734-615-8739
| | - Shanika Boyce
- Department of Pediatrics, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Cleopatra H. Caldwell
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
- Center for Research on Ethnicity, Culture, and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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Cobb S, Javanbakht A, Khalifeh Soltani E, Bazargan M, Assari S. Racial Difference in the Relationship Between Health and Happiness in the United States. Psychol Res Behav Manag 2020; 13:481-490. [PMID: 32547270 PMCID: PMC7259486 DOI: 10.2147/prbm.s248633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/24/2020] [Indexed: 02/03/2023] Open
Abstract
Background Although health is a prerequisite for happiness, the salience of health for maintaining happiness may be diminished for Blacks when compared to Whites, a phenomenon which can be explained by the Black-White mental health paradox and minorities’ diminished returns. Aim To understand if Black and White adult Americans differ in the effects of self-rated health (SRH) on happiness. Methods This cross-sectional study used data from the General Social Survey (GSS; 1972–2018), a nationally representative survey in the US. Our analytical sample included 42,201 Black and White adults. The independent variable was SRH. Happiness was the dependent variable. Sociodemographic factors were covariates. Race was the moderator. Logistic regression was used to analyze the data without and with interaction terms between race and SRH. Results Overall, good SRH was positively associated with happiness, however, there was a significant interaction between race/ethnicity and good SRH on the outcome (i.e. happiness) . This finding suggested that the boosting effect of good SRH on happiness is weaker for Black than White people. Conclusion In the United States, due to a weaker concordance between good health and happiness, Blacks who have poor SRH are more likely to report happiness. At the same time, Whites who are healthy report happiness, however, Blacks who are healthy do not necessarily report happiness. Disjointed link between health and happiness may be due to different racial, ethnic, and cultural perceptions of physical health and happiness as well as salience of physical health as a component of happiness. This may be an adaptive response of Blacks to sociopolitical as well as health-related adversities over centuries as a result of the combination of oppression, injustice, and poverty.
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Affiliation(s)
- Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Arash Javanbakht
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | | | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.,Department of Family Medicine, UCLA, Los Angeles, CA, USA
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
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Assari S, Boyce S, Caldwell CH, Bazargan M. Minorities' Diminished Returns of Parental Educational Attainment on Adolescents' Social, Emotional, and Behavioral Problems. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E49. [PMID: 32443584 PMCID: PMC7278850 DOI: 10.3390/children7050049] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/14/2020] [Accepted: 05/13/2020] [Indexed: 02/08/2023]
Abstract
Aim: To compare racial groups for the effect of parental educational attainment on adolescents' social, emotional, and behavioral problems. Methods: In this cross-sectional study, 10,762 youth from the Adolescent Brain Cognitive Development (ABCD) study were included. The independent variable was parental educational attainment. The main outcomes were 1) anxious and depressed mood, 2) withdrawn and depressed affect, 3) somatic complaints, 4) social and interpersonal problems, 5) thought problems, 6) rule-breaking behaviors, 7) attention problems, and 8) violent and aggressive behaviors. These scores were generated based on parent-reported behavioral problems measured using the Child Behavior Checklist (CBCL). Race and ethnicity were the moderators. Linear regression was used to analyze the ABCD data. Results: Overall, high parental educational attainment was associated with lower scores across all domains. Race and ethnicity showed statistically significant interactions with parental educational attainment on adolescents' fewer social, emotional, and behavioral problems (all domains), net of all confounders, indicating smaller tangible gains from their parental educational attainment for Black and Hispanic compared to non-Hispanic White adolescents. Conclusion: The protective effects of parental education against social, emotional, and behavioral problems are systematically diminished for Hispanic and Black than non-Hispanic White adolescents.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Shanika Boyce
- Department of Pediatrics, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Cleopatra H. Caldwell
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA;
- Center for Research on Ethnicity, Culture, and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
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Assari S. Age-Related Decline in Children's Reward Sensitivity: Blacks' Diminished Returns. RESEARCH IN HEALTH SCIENCE 2020; 5:112-128. [PMID: 33274304 DOI: 10.22158/rhs.v5n3p112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND It is important to study the correlates of reward sensitivity since it predicts high-risk behaviors. While ageing reduces children's reward sensitivity and its associated risk taking, there is more to find out about racial differences in regard to the effect of age on reward sensitivity. Minorities' Diminished Returns (MDRs) suggest that resources and assets show weaker effects on Black children than White children. AIM We compared White children to Black children as for the effects of age on reward sensitivity. METHODS This cross-sectional study included 10533 American children who participated in the baseline of the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was age, while the dependent variable was reward sensitivity as captured by the behavioral approach/behavioral avoidance system (BAS-BIS). Gender, parental education, marital status, parental education, and household income were the covariates. RESULTS Higher age was associated with less reward sensitivity. A significant interaction was found between race and age when it comes to children's reward sensitivity. It suggested that age is associated with a smaller gain in terms of reduced reward sensitivity in Black children than White children. CONCLUSION Age is more likely to reduce reward sensitivity in White children than Black children. This finding is in line with MDRs, and may be due to social racism, segregation, stratification, and discrimination.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.,Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Assari S. Parental Education and Nucleus Accumbens Response to Reward Anticipation: Minorities' Diminished Returns. ACTA ACUST UNITED AC 2020; 2:132-153. [PMID: 34308362 DOI: 10.22158/assc.v2n4p132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Considerable research has documented the effects of race and socioeconomic status (SES) on reward-seeking behaviors; however, less is known about the multiplicative effects of race and family SES on brain response to reward anticipation. Marginalization-related Diminished Returns (MDRs) suggest that family SES would show weaker effects on brain development of children in non-White families than in White families. Objective To test race by SES variation in Nucleus Accumbens (NAcc) response to reward anticipation (NAcc-RA) among American children. Methods For this cross-sectional analysis, data came from the Adolescent Brain Cognitive Development (ABCD) study which included 6,419, 9-10 year old children. The independent variable was parental education. The moderator was race. The primary outcome was the right NAcc-RA. Age, sex, ethnicity, household income, and family structure were the covariates. We used mixed effects regression models that adjusted for the nested nature of the ABCD data. Results While high parental education was associated with a higher amount of right NAcc-RA, this effect was stronger for White than non-White children. This finding was evident in the observed interactions between race and parental education on the right NAcc-RA. Discussion For American children, NAcc-RA is not shaped by race or family SES, but by their intersection. As a result of the interaction between race and SES (diminished return of SES for non-Whites), middle-class racial minority children may remain susceptible to high-risk behaviors. Disparities in high-risk behaviors in children should not be reduced to economic disparities. Structural inequalities may reduce the return of SES resources for non-White families.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles Drew University, Los Angeles, CA 90059, USA.,Department of Urban Public Health, Charles Drew University, Los Angeles, CA 90059, USA
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Assari S. Dimensional Change Card Sorting of American Children: Marginalization-Related Diminished Returns of Age. CHILDREN AND TEENAGERS 2020; 3:72-92. [PMID: 33299967 DOI: 10.22158/ct.v3n2p72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND While age is associated with an increase in cognitive flexibility and executive functioning as a result of normal development during childhood, less is known about the effect of racial variation in children's age-related cognitive development. The Marginalization-related Diminished Returns (MDRs) phenomenon suggests that, under racism, social stratification, segregation, and discrimination, individual-level economic and non-economic resources and assets show weaker effects on children's development for marginalized, racialized, and minoritized families. AIM We conducted this study to compare racial groups of children for age-related changes in their card sorting abilities. METHODS This cross-sectional study included 10,414 9-10-year-old American children. Data came from the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was age, a continuous variable measured in months. The dependent variable was dimensional change card sort (DCCS) score, which reflected cognitive flexibility, and was measured by the NIH Dimensional Change Card Sort. Ethnicity, sex, parental education, and marital status were the covariates. RESULTS Older age was associated with higher DCCS score, reflecting a higher card-sorting ability and cognitive flexibility. However, age showed a weaker association with DCCS for Black than for White children. This was documented by a significantly negative interaction between race and age on children's DCCS scores. CONCLUSION Age shows a weaker correlation with the cognitive flexibility of Black than of White children. A similar pattern can be seen when comparing low-income with high-income children. Conceptualizing race as a social factor that alters normal childhood development is a finding that is in line with MDRs. Marginalization due to social stratification and racism interfere with the normal age-related cognitive development of American children.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.,Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
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Assari S, Bazargan M. Baseline Obesity Increases 25-Year Risk of Mortality due to Cerebrovascular Disease: Role of Race. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3705. [PMID: 31581468 PMCID: PMC6801808 DOI: 10.3390/ijerph16193705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/23/2019] [Accepted: 09/28/2019] [Indexed: 12/14/2022]
Abstract
Background: Although obesity may have a role as a risk factor for cerebrovascular mortality, less is known about how demographic and social groups differ in this regard. Aims: This study had two aims: first to investigate the predictive role of baseline obesity on long-term risk of mortality due to cerebrovascular disease, and second, to test racial variation in this effect. Methods: the Americans' Changing Lives Study (ACL) 1986-2011 is a state of the art 25-year longitudinal cohort study. ACL followed a nationally representative sample of Blacks (n = 1156) and Whites (n = 2205) for up to 25 years. Baseline obesity was the main predictor of interest, time to cerebrovascular death was the main outcome of interest. Demographic characteristics, socioeconomic status (educational attainment and household income), health behaviors (exercise and smoking), and health (hypertension and depressive symptoms) at baseline were covariates. Cox proportional hazards models were used to test additive and multiplicative effects of obesity and race on the outcome. Results: From the total 3,361 individuals, 177 people died due to cerebrovascular causes (Whites and Blacks). In the pooled sample, baseline obesity did not predict cerebrovascular mortality (hazard ratio (HR) = 0.86, 0.49-1.51), independent of demographic, socioeconomic, health behaviors, and health factors at baseline. Race also interacted with baseline obesity on outcome (HR = 3.17, 1.09-9.21), suggesting a stronger predictive role of baseline obesity on cerebrovascular deaths for Black people compared to White individuals. According to the models that were run specific to each race, obesity predicted risk of cerebrovascular mortality for Blacks (HR = 2.51, 1.43-4.39) but not Whites (HR = 0.69, 0.31-1.53). Conclusions: Baseline obesity better predicts long-term risk of cerebrovascular death in Black individuals compared to White people. More research should explore factors that explain why racial differences exist in the effects of obesity on cerebrovascular outcome. Findings also have implications for personalized medicine.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
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Assari S. Marital Status and Physical Health: Racial Differences. INTERNATIONAL JOURNAL OF EPIDEMIOLOGIC RESEARCH 2019. [DOI: 10.15171/ijer.2019.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background and aims: As suggested by the Minorities’ Diminished Return Theory, the association between socioeconomic status and health is weaker for racial and ethnic minorities compared to Whites. The current study compared Blacks and Whites in terms of the association between marital status and physical health. Methods: The State of the State Survey (SOSS) included 881 adults (92 Blacks and 782 Whites) generalizable to the state of Michigan, the United States. The marital status and self-rated physical health (SRPH), which was measured using a single item, were considered as independent and dependent variables, respectively. In addition, age, gender, education, and employment were covariates and race/ ethnicity was regarded as the moderating factor. Finally, logistic regression was used for data analysis. Results: Based on the results, being married was associated with better SRPH, which is the net considered by all confounders. A significant interaction was found between race and marital status on SRPH, suggesting a larger association for Blacks compared to Whites. In race stratified models, marital status was related to better SRPH for Whites and Blacks, but the magnitude of this link was larger for Blacks compared to Whites. Conclusion: Overall, marital status was differently linked to SRPM for Whites and Blacks. Accordingly, policymakers should be cautious while not assuming that diverse racial and ethnic groups with similar economic resources have similar health status.
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Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109-2700, USA
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Assari S, Mistry R, Bazargan M. Race, Educational Attainment, and E-Cigarette Use. JOURNAL OF MEDICAL RESEARCH AND INNOVATION 2019; 4:10.32892/jmri.185. [PMID: 32090188 PMCID: PMC7034862 DOI: 10.32892/jmri.185] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although higher educational attainment lowers high-risk behaviors such as substance use, according to the Minorities' Diminished Returns theory, the effect of educational attainment may be smaller for Blacks than Whites. AIMS To explore the racial differences in the link between educational attainment and electronic cigarettes (e-cigarettes). METHODS We used the Health Information National Trends Survey (HINTS) data. This national survey was conducted in 2017 and included 2,277 American adults composed of 1,868 White and 409 Black individuals. Educational attainment was the independent variable. E-cigarette use (lifetime) was the dependent variables. Age and gender were the covariates. Race was the effect modifier. RESULTS In the overall sample, a higher level of education attainment was linked to lower odds of e-cigarette use (OR = 0.76, 95% CI =0.61-0.95). Race showed a significant interaction with educational attainment on the outcome (OR = 1.63, 95% CI =1.04-2.56), suggesting a weaker negative association between high educational attainment and e-cigarette use for Blacks than Whites. In race-stratified logistic regression models, high educational attainment was inversely associated with risk of e-cigarette use for Whites but not Blacks. CONCLUSIONS Educational attainment shows a stronger effect on e-cigarette use in White than Black Americans.
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Affiliation(s)
- Shervin Assari
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, 118th St, Los Angeles, CA, 90059, United States
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA
| | - Mohsen Bazargan
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, 118th St, Los Angeles, CA, 90059, United States
- Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
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Assari S, Javanbakht A, Saqib M, Helmi H, Bazargan M, Smith JA. Neuroticism polygenic risk score predicts 20-year burden of depressive symptoms for Whites but not Blacks. JOURNAL OF MEDICAL RESEARCH AND INNOVATION 2019; 4:e000183. [PMID: 32133428 PMCID: PMC7055662 DOI: 10.32892/jmri.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Black-White differences are reported in social, psychological, behavioral, medical, and biological correlates of depression. This study was conducted to compare Black and White older adults for the association between neuroticism polygenic risk score (N-PRS) and chronicity of depressive symptoms over 20 years. METHODS Data came from the Health and Retirement Study (HRS), 1990 - 2012, a nationally representative sample of Americans above age 50. Current analysis followed 9,249 individuals (7,924 Whites and 1,325 Blacks) for up to 22 years. Depressive symptoms were measured every two years between 1992 and 2012 using the 8-item Center for Epidemiological Studies-Depression Scale (CES-D-8). The independent variable was N-PRS. The dependent variable was average depressive symptoms between 1992 and 2012. Linear regression was used for data analysis. RESULTS In the pooled sample, higher N-PRS was associated with higher average depressive symptoms over the 20-year follow up period [b=0.01, 95%CI=0.00 to 0.04], net of all covariates. We also found an interaction between race and N-PRS [b=-0.02, 95%CI=-0.03 to 0.00], suggesting a stronger effect of N-PRS on 20-year average depressive symptoms for Whites than Blacks. Based on our race-specific linear regression models, higher N-PRS was associated with higher depressive symptoms from 1992 to 2012 for Whites [b=0.01, 95%CI=0.01 to 0.02] but not Blacks [b=0.00, 95%CI=-0.02 to 0.02]. CONCLUSION Black and White older adults may differ in the salience of the existing N-PRS for depressive symptoms, which better reflects the burden of depression for Whites than Blacks. This may be because the existing PRSs are derived from mostly or exclusively White samples, limiting their applicability in other race groups. Racial variation in psychosocial, clinical, and biological correlates of depression needs further research.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Arash Javanbakht
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, MI, USA
| | - Mohammed Saqib
- Department of Health Behavior and Health Education, School of Public health, University of Michigan, Ann Arbor, MI, USA
| | - Hamid Helmi
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
- School of Medicine, University of Chicago, IL, USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Jennifer A Smith
- Department of Epidemiology, School of Public health, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Assari S. Association between General Sense of Mastery and Income in White- and African-American Adults. Nurs Midwifery Stud 2019; 8:162-167. [PMID: 31396545 PMCID: PMC6686666 DOI: 10.4103/nms.nms_47_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Some research has shown that general sense of mastery (i.e., sense of control over the forces that impact one's life) does not have universal causes and consequences in racial groups. For instance, sense of mastery better predicts depression and mortality for non-Hispanic Whites (NHWs) than that of African-Americans (AAs). OBJECTIVES The objective of this study was to test the heterogeneity in the association between the sense of mastery and income by race in a nationally representative sample of NHW and AA adults. METHODS This study included a total of 3570 AA and 891 NHW adults who were enrolled to the National Survey of American Life. Variables included race/ethnicity, age, gender, socioeconomic status (SES and household income), and sense of mastery. Linear regression models were applied in the overall sample and also by race. RESULTS Overall, high sense of mastery was associated with high household income. In race-specific models, higher levels of sense of mastery were associated with high household income in AAs but not NHWs. CONCLUSIONS Racial differences exist in how sense of mastery and income are correlated. It is not clear whether high income generates more sense of mastery for AAs or high sense of mastery is more essential for generating high income for AAs. Policy-makers and clinicians should be aware that SES and sense of mastery are differently linked in AAs and NHWs.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles Drew University, Los Angeles, California, USA
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Assari S, Helmi H, Bazargan M. Health Insurance Coverage Better Protects Blacks than Whites against Incident Chronic Disease. Healthcare (Basel) 2019; 7:E40. [PMID: 30857371 PMCID: PMC6473312 DOI: 10.3390/healthcare7010040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 02/06/2023] Open
Abstract
Although the protective effect of health insurance on population health is well established, this effect may vary based on race/ethnicity. This study had two aims: (1) to test whether having health insurance at baseline protects individuals over a 10-year period against incident chronic medical conditions (CMC) and (2) to explore the race/ethnic variation in this effect. Midlife in the United States (MIDUS) is a national longitudinal study among 25⁻75 year-old American adults. The current study included 3572 Whites and 133 Blacks who were followed for 10 years from 1995 to 2004. Race, demographic characteristics (age and gender), socioeconomic status (educational attainment and personal income), and health insurance status were measured at baseline. Number of CMC was measured in 1995 and 2005. Linear regression models were used for data analysis. In the overall sample, having health insurance at baseline was inversely associated with an increase in CMC over the follow up period, net of covariates. Blacks and Whites differed in the magnitude of the effect of health insurance on CMC incidence, with a stronger protective effect for Blacks than Whites. In the U.S., health insurance protects individuals against incident CMC; however, the health return of health insurance may depend on race/ethnicity. This finding suggests that health insurance may better protect Blacks than Whites against developing more chronic diseases. Increasing Blacks' access to health insurance may be a solution to eliminate health disparities, given they are at a relative advantage for gaining health from insurance. These findings are discussed in the context of Blacks' diminished returns of socioeconomic resources. Future attempts should test replicability of these findings.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Sciences, Los Angeles, CA 90059, USA.
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Hamid Helmi
- School of Medicine, Wayne State University, Detroit, MI 48202, USA.
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Sciences, Los Angeles, CA 90059, USA.
- Department of Family Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.
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Anderson RT, Peres LC, Camacho F, Bandera EV, Funkhouser E, Moorman PG, Paddock LE, Peters ES, Abbott SE, Alberg AJ, Barnholtz-Sloan J, Bondy M, Cote ML, Schwartz AG, Terry P, Schildkraut JM. Individual, Social, and Societal Correlates of Health-Related Quality of Life Among African American Survivors of Ovarian Cancer: Results from the African American Cancer Epidemiology Study. J Womens Health (Larchmt) 2019; 28:284-293. [PMID: 30307782 PMCID: PMC6909765 DOI: 10.1089/jwh.2018.7025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE While the incidence of epithelial ovarian cancer (EOC) is lower among African American (AA) women compared with European American (EA) women, AA women have markedly worse outcomes. In this study, we describe individual, social, and societal factors in health-related quality of life (HRQL) in AA women diagnosed with EOC in the African American Cancer Epidemiology Study (AACES) that we hypothesize may influence a patient's capacity to psychosocially adjust to a diagnosis of cancer. METHODS There were 215 invasive EOC cases included in the analysis. HRQL was measured using the SF-8 component scores for physical (PCS) and mental (MCS) health. We used least squares regression to test the effects of individual dispositional factors (optimism and trait anxiety); social level (perceived social support); and societal-level factors (SES defined as low family income and low educational attainment, and perceived discrimination) on HRQL, while adjusting for patient age, tumor stage, body mass index, and comorbidity. Mediation analysis was applied to test whether social support and physical activity buffer impacts of EOC on HRQL. RESULTS Optimism, trait anxiety, social support, poverty, and past perceived discrimination were significantly associated with HRQL following diagnosis of EOC. Specifically, higher family income, lower phobic anxiety, and higher social support were associated with better wellbeing on the MCS and PCS (p < 0.01). Higher perceived discrimination was associated with both lower MCS and PCS, whereas higher optimism was associated with higher MCS. Physical activity (MET-min/week) and social support displayed significant overall mediation for effects of SES on MCS and PCS, but not for trait anxiety. CONCLUSIONS Both pre- and postdiagnosis characteristics of AA women with EOC are important predictors of HRQL after cancer diagnosis. Individual, social, and societal-level factors each contribute to HRQL status with EOC and should be assessed.
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Affiliation(s)
- Roger T. Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Lauren C. Peres
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Elisa V. Bandera
- Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Ellen Funkhouser
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia G. Moorman
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lisa E. Paddock
- Cancer Surveillance Research Program, New Jersey State Cancer Registry, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Edward S. Peters
- Epidemiology Program, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | - Sarah E. Abbott
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Anthony J. Alberg
- Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Jill Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa Bondy
- Cancer Prevention and Population Sciences Program, Baylor College of Medicine, Houston, Texas
| | - Michele L. Cote
- Karmanos Cancer Institute Population Studies and Disparities Research Program, Department of Oncology, Wayne State University, Detroit, Michigan
| | - Ann G. Schwartz
- Karmanos Cancer Institute Population Studies and Disparities Research Program, Department of Oncology, Wayne State University, Detroit, Michigan
| | - Paul Terry
- Department of Medicine, University of Tennessee Medical Center-Knoxville, Knoxville, Tennessee
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Baseline Body Mass Predicts Average Depressive Symptoms over the Next Two Decades for White but Not Black Older Adults. Geriatrics (Basel) 2019; 4:geriatrics4010014. [PMID: 31023982 PMCID: PMC6473455 DOI: 10.3390/geriatrics4010014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Although obesity and depression have a bidirectional association, this link may vary based on race. The current study tested racial variation in bidirectional links between depressive symptoms and body mass index (BMI) over 24 years of follow-up in older adults over the age of 50 in the United States. We hypothesized weaker bidirectional links in Blacks compared to Whites. Methods: Data came from waves 1 to 12 (1990 to 2014) of the Health and Retirement Study (HRS), an ongoing state-of-the-art national cohort. The study followed a representative sample of Americans (n = 15,194; 2,200 Blacks and 12,994 Whites) over the age of 50. Dependent variables were average depressive symptoms and BMI over 24 years, based on measurements every other year, from 1990 to 2014. Independent variables included baseline depressive symptoms and BMI. Covariates included age, gender, marital status, veteran status, and activities of daily living. Structural equation models were fitted to the data for data analysis. Results: In the pooled sample, bidirectional associations were found between BMI and depressive symptoms as baseline BMI predicted average depressive symptoms over time and baseline depressive symptoms predicted average BMI over 24 years. Racial differences were found in the bidirectional association between BMI and depressive symptoms, with both directions of the associations being absent for Blacks. For Whites, baseline BMI predicted average depressive symptoms over the next 24 years. Conclusion: Reciprocal associations between BMI and depressive symptoms over a 24-year period among individuals over the age of 50 vary for Blacks and Whites. As these associations are stronger for Whites than Blacks, clinical and public health programs that simultaneously target comorbid obesity and depression may be more appropriate for Whites than Blacks.
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Assari S. High sense of mastery reduces psychological distress for African American women but not African American men. ARCHIVES OF GENERAL INTERNAL MEDICINE 2019; 3:5-9. [PMID: 31289793 PMCID: PMC6615738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Recent research has suggested that relative to Whites, African Americans (AAs) may be at a systemic disadvantage regarding the health effects of socioeconomic position (SEP) indicators as well as psychological assets (e.g., sense of mastery). However, less is known about how these diminished returns differ between AA men and women. This study tested whether AA men and women differ in the mental health effects of high sense of mastery. The National Survey of American Life (NSAL, 2003) recruited 3570 AA adults who were either female (n = 2299) or male (n = 1271). Dependent variable was psychological distress. Independent variable was sense of mastery. Gender was the focal moderator. Age and educational attainment were the covariates. Multiple linear regression model was applied for statistical analysis. Overall, high sense of mastery was associated with lower psychological distress. Significant interaction was found between gender and sense of mastery on psychological distress suggestive of a stronger association for AA women compared to men. A smaller mental health gain of high sense of mastery for AA men compared to AA women is indicative of within race heterogeneity regarding diminished returns. Racism and discrimination may be why high sense of mastery does not translate to mental health gain for AA men.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Assari S. Parental Educational Attainment and Academic Performance of American College Students; Blacks' Diminished Returns. JOURNAL OF HEALTH ECONOMICS AND DEVELOPMENT 2019; 1:21-31. [PMID: 31372601 PMCID: PMC6673665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND As suggested by the Minorities' Diminished Returns (MDR) theory, socioeconomic status (SES) systemically results in smaller outcomes for non-Whites compared to Whites. We still know very little about diminished trans-generational returns of SES resources such as parental educational attainment (PEA). PURPOSE This cross-sectional study explored racial variation in the effect of PEA on the college students' grade point average (GPA) in the US. METHODS The Healthy Mind Study (HMS, 2016-2017) is a national telephone of college students in the US. The total sample was 18,072 domestic undergraduate college students who were either non-Hispanic Whites (n = 16,718; %92.50) or non-Hispanic Blacks (n = 1,354; %7.50). The independent variable was PEA. The main outcome was GPA measured using self-reported data. Age, gender, sexual orientation, transgender status, and financial difficulty were covariates. Race/ethnicity was the effect modifier. Linear regression models were used to analyze the data. RESULTS Overall, higher PEA was associated with a higher GPA, independent of all possible confounders. Race/ethnicity, however, showed a significant interaction with PEA on students' GPA, indicating a smaller positive effect of PEA on non-Hispanic Blacks compared to non-Hispanic Whites college students' GPA. Race/ethnicity stratified models also showed a larger effect for White than Black students. CONCLUSIONS The boosting effect of PEA in GPA is smaller for Black compared to White college students. US should systematically reduce extra costs of upward social mobility for racial and ethnic minority families.
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Affiliation(s)
- Shervin Assari
- Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
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Assari S, Bazargan M. Marital Status and Physical Health: Racial Differences. INTERNATIONAL JOURNAL OF EPIDEMIOLOGIC RESEARCH 2019; 6:108-113. [PMID: 31572801 PMCID: PMC6768071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES As suggested by the Minorities' Diminished Return theory, the association between socioeconomic status and health is weaker for racial and ethnic minorities compared to Whites. The current study compared Blacks and Whites in terms of the association between marital status and physical health. METHODS The State of the State Survey (2017) included 881 adults (92 Blacks and 782 Whites) generalizable to the state of Michigan, the United States. The marital status and self-rated physical health (SRPH), which was measured using a single item, were considered as independent and dependent variables, respectively. In addition, age, gender, education, and employment were covariates. Race/ethnicity was regarded as the moderating factor. Logistic regression was used for data analysis. RESULTS Based on the results, being married was associated with better SRPH, the net of all confounders. A significant interaction was found between race and marital status on SRPH, suggesting a larger association for Blacks compared to Whites. In race stratified models, marital status was related to better SRPH for Whites and Blacks, but the magnitude of this link was larger for Blacks compared to Whites. CONCLUSION Overall, marital status was differently linked to SRPM for Whites and Blacks. Accordingly, policymakers should be cautious while not assuming that diverse racial and ethnic groups with similar economic resources have similar health status.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA
- Department of Family Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
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Parental Educational Attainment and Mental Well-Being of College Students; Diminished Returns of Blacks. Brain Sci 2018; 8:brainsci8110193. [PMID: 30380617 PMCID: PMC6266217 DOI: 10.3390/brainsci8110193] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 01/03/2023] Open
Abstract
Background. According to the Minorities’ Diminished Returns (MDR) theory, the health returns of socioeconomic status (SES) are systemically smaller for Blacks compared to Whites. Less is known, however, about trans-generational aspects of such diminished gains. For example, the differential impact of parental educational attainment on differences in mental well-being between White versus Black college students remains unknown. Aims. With a national scope, this study explored racial differences in the effect of parental educational attainment on the mental well-being of college students in the United States. Methods. The Healthy Mind Study (HMS), 2016–2017, is a national telephone survey that included 41,898 college students. The sample was composed of Whites (n = 38,544; 92.0%) and Blacks (n = 3354; 8.0%). The independent variable was highest parental educational attainment. The dependent variable was mental well-being (mentally healthy days in the past month) which was measured using a single item. Age and gender were covariates. Race was the moderator. Logistic regression was used for data analysis. Results. In the pooled sample, high parental educational attainment was associated with better mental wellbeing, independent of race, age, and gender. Race, however, showed a significant interaction with parental educational attainment on students’ mental wellbeing, indicating a smaller effect of parent education on the mental wellbeing of Black compared to White college students. Conclusions. The returns of parental educational attainment in terms of mental well-being is smaller for Black college students compared to their White counterparts. To minimize the diminished returns of parental education in Black families, policies should go beyond equalizing SES and reduce the structural barriers that are common in the lives of Black families. Policies should also aim to reduce extra costs of upward social mobility, prevent discrimination, and enhance the quality of education for Blacks. As the mechanisms that are involved in MDR are multi-level, multi-level solutions are needed to minimize the racial gaps in gaining mental health benefits from higher socioeconomic levels.
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Takahashi PY, Jenkins GD, Welkie BP, McDonnell SK, Evans JM, Cerhan JR, Olson JE, Thibodeau SN, Cicek MS, Ryu E. Association of mitochondrial DNA copy number with self-rated health status. APPLICATION OF CLINICAL GENETICS 2018; 11:121-127. [PMID: 30498369 PMCID: PMC6207265 DOI: 10.2147/tacg.s167640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose In aging adults, mitochondrial dysfunction may be an important contributor. We evaluated the association between mitochondrial DNA (mtDNA) copy number, which is a biomarker for mitochondrial function, and self-rated health status. Patients and methods We conducted a cross-sectional study of patients enrolled within the Mayo Clinic Biobank. We utilized the questionnaire and sequence data from 944 patients. We examined the association between mtDNA copy number and self-rated health status with 3 collapsed categories for the latter variable (excellent/very good, good, and fair/poor). For analysis, we used proportional odds models after log-transforming mtDNA copy number, and we adjusted for age and sex. Results We found the median age at enrollment was 61 years (25th–75th percentile: 51–71), and 64% reported excellent or very good health, 31% reported good health, and 6% reported fair/poor health. Overall, the median mtDNA copy number was 88.9 (25th–75th percentile: 77.6–101.1). Higher mtDNA copy number was found for subjects reporting better self-rated health status after adjusting for age, sex, and comorbidity burden (OR =2.3 [95% CI: 1.2–4.5] for having better self-rated health for a one-unit increase in log-transformed mtDNA copy number). Conclusion We found that a higher mtDNA copy number is associated with better self-rated health status after adjustment for age, sex, and comorbidity burden. The current study implies that mtDNA copy number may serve as a biomarker for self-reported health. Further studies, potentially including cohort studies, may be required.
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Affiliation(s)
| | | | | | | | | | | | | | - Stephen N Thibodeau
- Department of laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mine S Cicek
- Department of laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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History of Non-Fatal Physical Assault Is Associated with Premature Mortality for Whites but Not Blacks. J 2018. [DOI: 10.3390/j1010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Exposure to trauma increases the long-term risk of mortality, and experiencing non-fatal physical assault is not an exception. To better understand population heterogeneity in this link, the current study explored Black–White differences in the association between history of non-fatal physical assault and risk of all-cause mortality over a 25-year period in the United States. Data came from the Americans’ Changing Lives (ACL) study that followed 3617 non-institutionalized respondents for up to 25 years. History of non-fatal physical assault at baseline was the predictor. Outcome was time to death due to all-cause mortality during follow-up from baseline (1986) to follow-up (2011). Confounders included gender, age, and baseline socio-economic status (education and income), health behaviors (smoking and drinking), and health status (chronic medical conditions, self-rated health, and body mass index). Race was the moderator. Cox regressions were used for multi-variable analysis. History of non-fatal physical assault at baseline was associated with an increased risk of mortality, above and beyond baseline socioeconomic status, health behaviors, and health status. Race interacted with history of non-fatal physical assault on mortality, suggesting a stronger effect for Whites compared to Blacks. In race-specific models, history of non-fatal physical assault was associated with risk of mortality for Whites but not Blacks. The current study showed that experiencing non-fatal physical assault increases the risk of premature death above and beyond demographics, socioeconomic status, health behaviors, and health status. Experiencing non-fatal physical assault may have a larger effect on premature mortality among Whites than Blacks. Future research is needed on how Blacks and Whites differ in the health consequences of social adversities.
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Assari S, Moghani Lankarani M. Depressive Symptoms and Self-Esteem in White and Black Older Adults in the United States. Brain Sci 2018; 8:E105. [PMID: 29891800 PMCID: PMC6024986 DOI: 10.3390/brainsci8060105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 05/24/2018] [Accepted: 06/09/2018] [Indexed: 01/03/2023] Open
Abstract
Background. Poor self-esteem is a core element of depression. According to recent research, some racial groups may vary in the magnitude of the link between depression and poor self-esteem. Using a national sample, we compared Black and White older Americans for the effect of baseline depressive symptoms on decline in self-esteem over time. Methods. This longitudinal study used data from the Religion, Aging, and Health Survey, 2001⁻2004. The study followed 1493 older adults (734 Black and 759 White) 65 years or older for three years. Baseline depressive symptoms (CES-D), measured in 2001, was the independent variable. Self-esteem, measured at the end of the follow up, was the dependent variable. Covariates included baseline demographic characteristics (age and gender), socioeconomic factors (education, income, and marital status), health (self-rated health), and baseline self-esteem. Race/ethnicity was the moderator. Linear multi-variable regression models were used for data analyses. Results. In the pooled sample, higher depressive symptoms at baseline were predictive of a larger decline in self-esteem over time, net of covariates. We found a significant interaction between race/ethnicity and baseline depressive symptoms on self-esteem decline, suggesting a weaker effect for Blacks compared to Whites. In race/ethnicity-specific models, high depressive symptoms at baseline was predictive of a decline in self-esteem for Whites but not Blacks. Conclusion. Depressive symptoms may be a more salient contributor to self-esteem decline for White than Black older adults. This finding has implications for psychotherapy and cognitive behavioral therapy of depression of racially diverse populations.
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Affiliation(s)
- Shervin Assari
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA.
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2700, USA.
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Parental Education Better Helps White than Black Families Escape Poverty: National Survey of Children’s Health. ECONOMIES 2018. [DOI: 10.3390/economies6020030] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Assari S. Diminished Economic Return of Socioeconomic Status for Black Families. SOCIAL SCIENCES (BASEL, SWITZERLAND) 2018; 7:74. [PMID: 32832108 PMCID: PMC7440031 DOI: 10.3390/socsci7050074] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND According to the Minorities' Diminished Return theory, socioeconomic status (SES) systemically generates larger gains for Whites compared to Blacks. It is, however, unknown whether the effects of baseline SES on future family income also varies between Blacks and Whites. AIMS Using a national sample, this study investigated racial variation in the effects of family SES (i.e., family structure, maternal education, and income) at birth on subsequent household income at age 15. METHODS This 15-year longitudinal study used data from the Fragile Families and Child Wellbeing Study (FFCWS), which followed 1471 non-Hispanic Black or White families from the time of birth of their child for 15 years. Two family SES indicators (maternal education and income) at birth were the independent variables. Family income 15 years later was the outcome. Maternal age, child gender, and family structure at baseline were covariates. Race was the focal moderator. Linear regression models were used for data analysis. RESULTS In the pooled sample, maternal education (b = 11.62, p < 0.001) and household income (b = 0.73, p < 0.001) at baseline were predictive of family income 15 years later. Race, however, interacted with maternal education (b = -12,073.89, p < 0.001) and household income (b = -312.47, p < 0.001) at birth on household income 15 years later, indicating smaller effects for Black compared to White families. These differential gains were independent of family structure, mother age, and child gender. CONCLUSIONS The economic return of family SES is smaller for Black compared to White families, regardless of the SES indicator. Policies should specifically address structural barriers in the lives of racial and ethnic minorities to minimize the diminished return of SES resources across racial minority groups. Policies should also reduce extra costs of upward social mobility for racial minorities. As the likely causes are multi-level, solutions should also be also multi-level. Without such interventions, it may be very difficult if not impossible to eliminate the existing Black-White economic gap.
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Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
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Assari S, Gibbons FX, Simons RL. Perceived Discrimination among Black Youth: An 18-Year Longitudinal Study. Behav Sci (Basel) 2018; 8:E44. [PMID: 29702587 PMCID: PMC5981238 DOI: 10.3390/bs8050044] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 01/08/2023] Open
Abstract
Background: Recent research has suggested vulnerability to perceived racial discrimination (PRD) as a mechanism behind high levels of depression seen in high socioeconomic status (SES) Black males. To better understand the effects of gender and SES on shaping experiences of PRD among Black youth in the United States, we used data from the Family and Community Health Study (FACHS) to explore the trajectory of PRD in Black youth by gender, SES, and place. Methods: Data came from FACHS, 1997⁻2017, which followed 889 children aged 10⁻12 years old at Wave 1 (n = 478; 53.8% females and n = 411; 46.2% males) for up to 18 years. Data were collected in seven waves. The main predictors of interest were gender, SES (parent education and annual family income), age, and place of residence. Main outcomes of interest were baseline and slope of PRD. Latent growth curve modeling (LGCM) was used for data analysis. Results: Gender, SES, place, and age were correlated with baseline and change in PRD over time. Male, high family income, and younger Black youth reported lower PRD at baseline but a larger increase in PRD over time. Youth who lived in Iowa (in a predominantly White area) reported higher PRD at baseline and also an increase in PRD over time. High parental education was not associated with baseline or change in PRD. Conclusion: In the United States, Black youth who are male, high income, and live in predominantly White areas experience an increase in PRD over time. Future research is needed on the interactions between gender, SES, and place on exposure and vulnerability of Black youth to PRD. Such research may explain the increased risk of depression in high SES Black males.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, SPC 5763, Ann Arbor, MI 48109-2700, USA.
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2700, USA.
| | - Frederick X Gibbons
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA.
| | - Ronald L Simons
- Department of Sociology, University of Georgia, Athens, GA 30602, USA.
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