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Marlow EC, Wysocki KL, Wehling KA. Addressing racial disparities in cancer care: A collaborative grant initiative. Cancer 2024; 130 Suppl 20:3558-3560. [PMID: 37831660 DOI: 10.1002/cncr.35033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/14/2023] [Indexed: 10/15/2023]
Abstract
A competitive grants program developed by the American Cancer Society and Pfizer Global Medical Grants funded 10 quality improvement projects aimed at reducing systemic barriers and addressing cancer disparities for Black men and women. This introduction details the purpose and scope of this program and addresses the potential for similar projects addressing disparities along the cancer care continuum.
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Westrick AC, Zhu P, Friese CR, Langa KM, Kobayashi LC. The association of pre-cancer diagnosis cardiovascular risk factors with memory aging after a cancer diagnosis, overall and by race/ethnicity. J Cancer Surviv 2024; 18:1144-1153. [PMID: 38647590 DOI: 10.1007/s11764-024-01593-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Cardiovascular risk factors (CVRFs) are associated with increased risk for cognitive impairment and decline in the general population, but less is known about how CVRFs might influence cognitive aging among older cancer survivors. We aimed to determine how CVRFs prior to a cancer diagnosis affect post-cancer diagnosis memory aging, compared to cancer-free adults, and by race/ethnicity. METHODS Incident cancer diagnoses and memory (immediate and delayed recall) were assessed biennially in the US Health and Retirement Study (N = 5,736, 1998-2018). CVRFs measured at the wave prior to a cancer diagnosis included self-reported cigarette smoking, obesity, diabetes, heart disease, hypertension, and stroke. Multivariable-adjusted linear mixed-effects models evaluated the rate of change in standardized memory score (SD/decade) post-cancer diagnosis for those with no, medium, and high CVRFs, compared to matched cancer-free adults, overall and stratified by sex and race/ethnicity. RESULTS Higher number of CVRFs was associated with worse baseline memory for both men and women, regardless of cancer status. Cancer survivors with medium CVRFs had slightly slower rates of memory decline over time relative to cancer-free participants (0.04 SD units/decade [95% CI: 0.001, 0.08]). Non-Hispanic Black (NHB) and Hispanic cancer-free participants and cancer survivors had worse baseline memory than their Non-Hispanic White (NHW) counterparts. CONCLUSIONS CVRFs were associated with worse baseline memory function, but not decline, for cancer-free adults and cancer survivors. Racial disparities were largely similar between cancer survivors and cancer-free adults. IMPLICATIONS FOR CANCER SURVIVORS These findings may inform hypotheses about pre-diagnosis multimorbidity and cognitive aging of cancer survivors from diverse groups.
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Affiliation(s)
- Ashly C Westrick
- Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Peiyao Zhu
- Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Christopher R Friese
- Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Langa
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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Bauldry S, Thomas PA, Sauerteig-Rolston MR, Ferraro KF. Educational Inequalities in Dual-Function Life Expectancy. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae072. [PMID: 38685796 PMCID: PMC11157625 DOI: 10.1093/geronb/gbae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES This study investigates educational inequalities in dual functionality, a new concept that captures a combination of physical and cognitive functioning, both of which are important for independent living and quality of life. METHODS Using data from the Health and Retirement Study and the National Health Interview Survey Linked Mortality Files, we define a measure of dual functionality based on the absence of limitations in activities of daily living and dementia. We estimate age-graded dual-function rates among adults 65+ and age-65 dual-function life expectancy across levels of education stratified by gender. RESULTS In their mid-60s, 67% of women with less than a high school degree manifest dual functionality as compared with over 90% of women with at least a 4-year college degree. A similar pattern holds among men. These education-based gaps in dual functionality remain across later life, even as dual-function rates decline at older ages. Lower dual-function rates among older adults with less education translate into inequalities of 6.7 and 7.3 years in age-65 dual-function life expectancy between men and women, respectively, with at least a 4-year college degree compared to their counterparts with less than a high school degree. DISCUSSION Older adults, particularly women, with less than a high school degree are estimated to live a smaller percentage of their remaining years with dual functionality compared with older adults with at least a college degree. These inequalities have implications for the distribution of caregiving resources of individuals, family members, and the broader healthcare community.
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Affiliation(s)
- Shawn Bauldry
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Patricia A Thomas
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Madison R Sauerteig-Rolston
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Kenneth F Ferraro
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
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Luo L, Wei L. For Whom Does Education Convey Health Benefits? A Two-Generation and Life Course Approach. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241249120. [PMID: 38832718 DOI: 10.1177/00221465241249120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Scholars of social determinants of health have long been interested in how parent's and own education influence health. However, the differing effects of parent's and own education on health-that is, for what socioeconomic group education conveys health benefits-are relatively less studied. Using multilevel marginal structural models, we estimate the heterogeneous effects of parent's and own education over the life course on two health measures. Our analysis considers both parent's and respondent's pre-education covariates, such as childhood health and socioeconomic conditions. We find that the protective effects of college completion against negative health outcomes are remarkably similar regardless of parent's (measured by father's or mother's) education. Meanwhile, parent's education has a larger effect when the average educational level is low in the population. Our results also reveal distinct life course patterns between health measures. We conclude by discussing the implications of our study for understanding the education-health relationship.
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Affiliation(s)
- Liying Luo
- The Pennsylvania State University, University Park, PA, USA
| | - Lai Wei
- University of Hong Kong, Hong Kong, China
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Gaydosh L, Harris KM. Institutional Context Shapes the Physical Health of College Graduates Differently for U.S. White, Black, and Hispanic Adults. Demography 2024; 61:933-966. [PMID: 38809598 DOI: 10.1215/00703370-11380743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Greater educational attainment is generally associated with healthier and longer lives. However, important heterogeneity in who benefits from educational attainment, how much, and why remains underexplored. In particular, in the United States, the physical health returns to educational attainment are not as large for minoritized racial and ethnic groups compared with individuals racialized as White. Yet, our current understanding of ethnoracial differences in educational health disparities is limited by an almost exclusive focus on the quantity of education attained without sufficient attention to heterogeneity within educational attainment categories, such as different institution types among college graduates. Using biomarker data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we test whether the physical health of college graduates in early adulthood (aged 24-32) varies by institution type and for White, Black, and Hispanic adults. In considering the role of the college context, we conceptualize postsecondary institutions as horizontally stratified and racialized institutional spaces with different implications for the health of their graduates. Finally, we quantify the role of differential attendance at and returns to postsecondary institution type in shaping ethnoracialized health disparities among college graduates in early adulthood.
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Affiliation(s)
- Lauren Gaydosh
- Department of Sociology and Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Kathleen Mullan Harris
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Meza E, Hebert J, Garcia ME, Torres JM, Glymour MM, Vable AM. First-generation college graduates have similar depressive symptoms in midlife as multi-generational college graduates. SSM Popul Health 2024; 25:101633. [PMID: 38434443 PMCID: PMC10905036 DOI: 10.1016/j.ssmph.2024.101633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose Higher education may protect an individual against depressive symptoms, yet, disadvantaged socioeconomic status (SES) during childhood, often measured by lower parental education, may put them at higher risk for depressive symptoms later in life. This study evaluates if midlife depression is similar for first-generation and multi-generation college graduates. Methods For US Health and Retirement Study (HRS) participants ages 55-63 (N = 16,752), we defined a 4-category exposure from parents' (highest of mother or father's) and participant's own years of education, with 16 years indicating college completion: multi-gen (both ≥ 16 years: reference); first-gen (parents <16; own ≥ 16); only parent(s) (parents ≥ 16; own <16); and neither (both <16) college graduates across three birth cohorts. We used linear regressions to evaluate relationships between college completion and depressive symptoms measured by an 8-item Center for Epidemiologic Studies - Depression (CES-D) scale. Models pooled over time evaluated differences by sex, race/ethnicity, and birthplace. Results First-gen and multi-gen college graduates averaged similar depressive symptoms in midlife (β : 0.01; 95% CI: 0.15, 0.13). Results were similar by sex and race/ethnicity. Conclusion Consistent with resource substitution theory, college completion may offset the deleterious effects of lower parental education on midlife depressive symptoms for first-generation graduates.
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Affiliation(s)
- Erika Meza
- Department of Epidemiology and Biostatistics University of California, San Francisco, 550 16th St 2nd Floor, San Francisco, CA, 94158, USA
- Center for Population and Development Studies Harvard University, 9 Bow St. Cambridge, MA 02138, USA
| | - Jillian Hebert
- Department of Family and Community Medicine University of California, San Francisco, 995 Potrero Ave, San Francisco, CA, 94110, USA
| | - Maria E. Garcia
- Department of Epidemiology and Biostatistics University of California, San Francisco, 550 16th St 2nd Floor, San Francisco, CA, 94158, USA
- Division of General Internal Medicine, University of California, San Francisco, 1701 Divisadero St, San Francisco, CA, 94115, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics University of California, San Francisco, 550 16th St 2nd Floor, San Francisco, CA, 94158, USA
| | - M. Maria Glymour
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, USA
| | - Anusha M. Vable
- Department of Family and Community Medicine University of California, San Francisco, 995 Potrero Ave, San Francisco, CA, 94110, USA
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Thyden NH, Slaughter-Acey J, Widome R, Warren JR, Osypuk TL. Family deaths in the early life course and their association with later educational attainment in a longitudinal cohort study. Soc Sci Med 2023; 333:116161. [PMID: 37595424 PMCID: PMC10529887 DOI: 10.1016/j.socscimed.2023.116161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/11/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Abstract
Due to structural racism and pathways between racism and health, Black and Native American people die at younger ages than white people. This means that those groups are likely to experience deaths of family members at younger ages. Evidence is mixed about whether family deaths affect educational attainment. We aim to 1) estimate the prevalence of family deaths by age and race 2) estimate the effect of a family death on later educational attainment and 3) analyze whether the effect of a family death varies by age, socioeconomic status, gender, and race. The National Longitudinal Study of Adolescent to Adult Health (Add Health) is a nationally representative sample of U.S. adolescents in grades 7-12 at baseline in 1994-1995. Add Health has a large and racially diverse sample and records family deaths across the entire life course starting from birth. Participants were included in this analysis if they reported their educational attainment in Wave IV (N = 14,796). The racial group with the lowest proportion experiencing a sibling or parent death in the first 23 years of their lives was white participants (11.7%), followed by Asian (12.5%), Hispanic (15.0%), Black (24.3%) and Native American participants (30.3%). In adjusted models, those who experienced a family death had 0.60 times the odds (95% CI 0.51-0.71) of achieving a bachelor's degree compared to those without a family death. Mother deaths, father deaths, and sibling deaths were each harmful for obtaining a college degree and their effects were similar in magnitude. The age range when the effect of a family death was strongest was 10-13 years old (OR = 0.52 95% CI 0.40-0.67). The effect of a family death on college degree attainment did not vary by baseline parent education, participant sex, or race/ethnicity.
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Affiliation(s)
- Naomi Harada Thyden
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States; University of Minnesota, Minnesota Population Center, United States; University of Illinois Chicago, School of Public Health, Community Health Sciences, United States.
| | - Jaime Slaughter-Acey
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States
| | - Rachel Widome
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States
| | - John Robert Warren
- University of Minnesota, Minnesota Population Center, United States; University of Minnesota, Department of Sociology, United States
| | - Theresa L Osypuk
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States; University of Minnesota, Minnesota Population Center, United States
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Cintron DW, Calmasini C, Barnes LL, Mungas DM, Whitmer RA, Eng CW, Gilsanz P, George KM, Peterson R, Glymour MM. Evaluating interpersonal discrimination and depressive symptoms as partial mediators of the effects of education on cognition: Evidence from the Study of Healthy Aging in African Americans (STAR). Alzheimers Dement 2023; 19:3138-3147. [PMID: 36724372 PMCID: PMC10390650 DOI: 10.1002/alz.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/18/2022] [Accepted: 12/20/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Education is correlated with positive health outcomes, but associations are sometimes weaker among African Americans. The extent to which exposure to discrimination and depressive symptoms attenuates the education-cognition link has not been investigated. METHODS Study of Healthy Aging in African Americans (STAR) participants (n = 764; average age 69 years) completed the Spanish and English Neuropsychological Assessment Scales. We assessed everyday and major lifetime discrimination and depressive symptoms as mediators of education effects on cognition using G-estimation with measurement error corrections. RESULTS Education was correlated with greater major lifetime and everyday discrimination but lower depressive symptoms. Accounting for discrimination and depressive symptoms slightly reduced the estimated effect of education on cognition. The estimated total effect of graduate education (vs DISCUSSION Education has robust effects on later-life cognition after controlling multiple mediating pathways and offsetting mechanisms.
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Affiliation(s)
- Dakota W. Cintron
- Center for Health and Community, University of California, San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Camilla Calmasini
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - Dan M. Mungas
- Department of Neurology, University of California Davis Health, Sacramento, CA, USA
| | - Rachel A. Whitmer
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Chloe W. Eng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Paola Gilsanz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kristen M. George
- Department of Neurology, University of California Davis Health, Sacramento, CA, USA
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Rachel Peterson
- Department of Neurology, University of California Davis Health, Sacramento, CA, USA
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - M. Maria Glymour
- Center for Health and Community, University of California, San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Hayes-Larson E, Ikesu R, Fong J, Mobley TM, Gee GC, Brookmeyer R, Whitmer RA, Gilsanz P, Mayeda ER. Association of Education With Dementia Incidence Stratified by Ethnicity and Nativity in a Cohort of Older Asian American Individuals. JAMA Netw Open 2023; 6:e231661. [PMID: 36877520 PMCID: PMC9989900 DOI: 10.1001/jamanetworkopen.2023.1661] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
IMPORTANCE High education protects against dementia, but returns on educational attainment may be different across sociodemographic groups owing to various social factors. Asian American individuals are a growing and diverse group, but little research has assessed dementia determinants in this population. OBJECTIVE To examine the association of education with dementia in a large cohort of Asian American individuals, stratifying by ethnicity and nativity. DESIGN, SETTING, AND PARTICIPANTS This cohort study used electronic health record (EHR) and survey data from the Research Program on Genes, Environment, and Health and the California Men's Health Study surveys (2002-2020). Data are from Kaiser Permanente Northern California, an integrated health care delivery system. This study used a volunteer sample who completed the surveys. Participants included Chinese, Filipino, and Japanese individuals who were aged 60 to less than 90 years without a dementia diagnosis in the EHR at the time of the survey (baseline) and who had 2 years of health plan coverage before baseline. Data analysis was performed from December 2021 to December 2022. EXPOSURES The main exposure was educational attainment (college degree or higher vs less than a college degree), and the main stratification variables were Asian ethnicity and nativity (born in the US or born outside the US). MAIN OUTCOMES AND MEASURES The primary outcome was incident dementia diagnosis in the EHR. Dementia incidence rates were estimated by ethnicity and nativity, and Cox proportional hazards and Aalen additive hazards models were fitted for the association of college degree or higher vs less than a college degree with time to dementia, adjusting for age (timescale), sex, nativity, and an interaction between nativity and college degree. RESULTS Among 14 749 individuals, the mean (SD) age at baseline was 70.6 (7.3) years, 8174 (55.4%) were female, and 6931 (47.0%) had attained a college degree. Overall, among individuals born in the US, those with a college degree had 12% lower dementia incidence (HR, 0.88; 95% CI, 0.75-1.03) compared with those without at least a college degree, although the confidence interval included the null. The HR for individuals born outside the US was 0.82 (95% CI, 0.72-0.92; P = .46 for the college degree by nativity interaction). The findings were similar across ethnicity and nativity groups except for Japanese individuals born outside the US. CONCLUSIONS AND RELEVANCE These findings suggest that college degree attainment was associated with lower dementia incidence, with similar associations across nativity. More work is needed to understand determinants of dementia in Asian American individuals and to elucidate mechanisms linking educational attainment and dementia.
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Affiliation(s)
- Eleanor Hayes-Larson
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Ryo Ikesu
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Joseph Fong
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Taylor M. Mobley
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Gilbert C. Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
| | - Ron Brookmeyer
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | - Rachel A. Whitmer
- Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento
- Alzheimer’s Disease Center, University of California, Davis Health, Sacramento
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
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Chireh B, Essien SK, Novik N, Ankrah M. Long working hours, perceived work stress, and common mental health conditions among full-time Canadian working population: a national comparative study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Lee KS, Yang Y. Educational attainment and emotional well-being in adolescence and adulthood. SSM - MENTAL HEALTH 2022; 2:100138. [PMID: 36704067 PMCID: PMC9875584 DOI: 10.1016/j.ssmmh.2022.100138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Education has been conceptualized as a causal factor leading to emotional well-being. However, it is also possible that some of the effect of education may be due to selection factors. Analyzing data from the National Longitudinal Study of Adolescent to Adult Health (n = 10,908), we asked: to what extent does educational attainment increase emotional well-being once stable observed and unobserved individual characteristics are accounted for? Findings from fixed effects models showed that attaining a college degree was associated with greater emotional well-being. However, interactions with gender indicate that the positive association with emotional well-being is primarily for women, although a small negative association between completing college and depressive affect was found for men. These findings point to unmeasured confounding factors as motivating some of the association between educational attainment and emotional well-being among adolescents and adults.
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Affiliation(s)
| | - Yulin Yang
- University of California, San Francisco, United States
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12
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Côté-Gendreau M, Donnelly Moran K. Geographic heterogeneity in Black-white infant mortality disparities. Front Public Health 2022; 10:995585. [PMID: 36408030 PMCID: PMC9669983 DOI: 10.3389/fpubh.2022.995585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Despite recent decreases in Black infant mortality, racial disparities persist, motivating continued research into factors related to these inequalities. While the inverse association between education and infant mortality has been documented across races, less is known about its geographic heterogeneity. Using vital statistics from the National Center for Health Statistics, this study considers Black-white disparities in infant mortality for births occurring between 2011 and 2015 across regions and metropolitan status of maternal residence. With logistic regressions, we investigate heterogeneity in maternal educational gradients of infant mortality by geographic residence both within and between races. Beyond confirming the well-known relationship between education and infant mortality, our findings document a slight metropolitan advantage for infants born to white mothers as well as lower returns to education for infants born to Black mothers residing in nonmetropolitan counties. We observe a metropolitan advantage for infants born to Black mothers with at least a bachelor's degree, but a metropolitan disadvantage for infants born to Black mothers with less than a high school degree. The South is driving this divergence, pointing to particular mechanisms limiting returns to education for Southern Black mothers in nonmetropolitan areas. This paper's geographic perspective emphasizes that racial infant health disparities are not uniform across the country and cannot be fully understood through individual and household characteristics.
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Affiliation(s)
- Marielle Côté-Gendreau
- Office of Population Research, Princeton University, Princeton, NJ, United States,*Correspondence: Marielle Côté-Gendreau
| | - Katie Donnelly Moran
- Office of Population Research, Princeton University, Princeton, NJ, United States,Department of Sociology, Princeton University, Princeton, NJ, United States,Katie Donnelly Moran
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Thomas MD, Calmasini C, Seblova D, Lapham S, Peters K, Prescott CA, Mangurian C, Glymour MM, Manly JJ. Postsecondary Education and Late-life Cognitive Outcomes Among Black and White Participants in the Project Talent Aging Study: Can Early-life Cognitive Skills Account for Educational Differences in Late-life Cognition? Alzheimer Dis Assoc Disord 2022; 36:215-221. [PMID: 35791067 PMCID: PMC9420770 DOI: 10.1097/wad.0000000000000519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/27/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Higher education consistently predicts improved late-life cognition. Racial differences in educational attainment likely contribute to inequities in dementia risk. However, few studies of education and cognition have controlled for prospectively measured early-life confounders or evaluated whether the education late-life cognition association is modified by race/ethnicity. METHODS Among 2343 Black and White Project Talent Aging Study participants who completed telephone cognitive assessments, we evaluated whether the association between years of education and cognition (verbal fluency, memory/recall, attention, and a composite cognitive measure) differed by race, and whether these differences persisted when adjusting for childhood factors, including the cognitive ability. RESULTS In fully adjusted linear regression models, each additional year of education was associated with higher composite cognitive scores for Black [β=0.137; 95% confidence interval (CI)=0.068, 0.206] and White respondents (β=0.056; CI=0.034, 0.078) with an interaction with race ( P =0.03). Associations between education and memory/recall among Black adults (β=0.036; CI=-0.037, 0.109) and attention among White adults (β=0.022; CI=-0.002, 0.046) were nonsignificant. However, there were significant race-education interactions for the composite ( P =0.03) and attention measures ( P <0.001) but not verbal fluency ( P =0.61) or memory/recall ( P =0.95). CONCLUSION Education predicted better overall cognition for both Black and White adults, even with stringent control for prospectively measured early-life confounders.
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Affiliation(s)
- Marilyn D Thomas
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
- University of California, San Francisco, School of Medicine, Department of Psychiatry and Behavioral Sciences, San Francisco, CA, USA
| | - Camilla Calmasini
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | | | - Susan Lapham
- American Institutes for Research, Washington, DC, USA
| | - Kelly Peters
- American Institutes for Research, Washington, DC, USA
| | | | - Christina Mangurian
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
- University of California, San Francisco, School of Medicine, Department of Psychiatry and Behavioral Sciences, San Francisco, CA, USA
| | - M. Maria Glymour
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
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14
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Beydoun MA, Beydoun HA, Noren Hooten N, Maldonado AI, Weiss J, Evans MK, Zonderman AB. Epigenetic clocks and their association with trajectories in perceived discrimination and depressive symptoms among US middle-aged and older adults. Aging (Albany NY) 2022; 14:5311-5344. [PMID: 35776531 PMCID: PMC9320538 DOI: 10.18632/aging.204150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
Background: Perceived discrimination may be associated with accelerated aging later in life, with depressive symptoms acting as potential mediator. Methods: A nationally representative sample of older adults was used [Health and Retirement Study 2010–2016, Age: 50–100 y in 2016, N = 2,806, 55.6% female, 82.3% Non-Hispanic White (NHW)] to evaluate associations of perceived discrimination measures [Experience of discrimination or EOD; and Reasons for Perceived discrimination or RPD) and depressive symptoms (DEP)] with 13 DNAm-based measures of epigenetic aging. Group-based trajectory and four-way mediation analyses were used. Results: Overall, and mostly among female and NHW participants, greater RPD in 2010–2012 had a significant adverse total effect on epigenetic aging [2016: DNAm GrimAge, DunedinPoAm38 (MPOA), Levine (PhenoAge) and Horvath 2], with 20–50% of this effect being explained by a pure indirect effect through DEP in 2014–2016. Among females, sustained elevated DEP (2010–2016) was associated with greater LIN DNAm age (β ± SE: +1.506 ± 0.559, p = 0.009, reduced model), patterns observed for elevated DEP (high vs. low) for GrimAge and MPOA DNAm markers. Overall and in White adults, the relationship of the Levine clock with perceived discrimination in general (both EOD and RPD) was mediated through elevated DEP. Conclusions: Sustained elevations in DEP and RPD were associated with select biological aging measures, consistently among women and White adults, with DEP acting as mediator in several RPD-EPICLOCK associations.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Ana I Maldonado
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD 21250, USA
| | - Jordan Weiss
- Department of Demography, University of California Berkeley, Berkeley, CA 94720, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD 21224, USA
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15
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VanDam M, Thompson L, Wilson-Fowler E, Campanella S, Wolfenstein K, De Palma P. Conversation Initiation of Mothers, Fathers, and Toddlers in their Natural Home Environment. COMPUT SPEECH LANG 2022; 73:101338. [PMID: 34970021 PMCID: PMC8713565 DOI: 10.1016/j.csl.2021.101338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a conversational exchange, interlocutors use social cues including conversational turn-taking to communicate. There has been attention in the literature concerning how mothers, fathers, boys, and girls converse with each other, and in particular who initiates a conversation. Better understanding of conversational dynamics may deepen our understanding of social roles, speech and language development, and individual language variability. Here we use large-scale automatic analysis of 186 naturalistic daylong acoustic recordings to examine the conversational dynamics of 26 families with children about 30 months of age to better understand communication roles. Families included 15 with boys and 11 with girls. There was no difference in conversation initiation rate by child sex, but children initiated more conversations than mothers, and mothers initiated more than fathers. Results support developmental theories of the different and variable roles that interlocutors play in a social context.
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Affiliation(s)
- Mark VanDam
- Speech & Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
- Hearing Oral Program of Excellence of Spokane, HOPE School, 502 E. 5 Ave., Spokane, WA 99202, USA
| | - Lauren Thompson
- Speech & Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Elizabeth Wilson-Fowler
- Communication Sciences and Disorders, Eastern Washington University, 310 North Riverpoint Blvd, Box B, Spokane, WA, 99202, USA
| | - Sarah Campanella
- Speech & Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Kiley Wolfenstein
- Speech & Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Paul De Palma
- Computer Science, School of Engineering and Applied Science, Gonzaga University, 502 E. Boone Ave., Spokane, WA, 99258, USA
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16
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Cintron DW, Adler NE, Gottlieb LM, Hagan E, Tan ML, Vlahov D, Glymour MM, Matthay EC. Heterogeneous treatment effects in social policy studies: An assessment of contemporary articles in the health and social sciences. Ann Epidemiol 2022; 70:79-88. [PMID: 35483641 DOI: 10.1016/j.annepidem.2022.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE . Social policies are important determinants of population health but may have varying effects on subgroups of people. Evaluating heterogeneous treatment effects (HTEs) of social policies is critical to determine how social policies will affect health inequities. Methods for evaluating HTEs are not standardized. Little is known about how often and by what methods HTEs are assessed in social policy and health research. METHODS . A sample of 55 articles from 2019 on the health effects of social policies were evaluated for frequency of reporting HTEs; for what subgroupings HTEs were reported; frequency of a priori specification of intent to assess HTEs; and methods used for assessing HTEs. RESULTS . 24 (44%) studies described some form of HTE assessment, including by age, gender, education, race/ethnicity, and/or geography. Among studies assessing HTEs, 63% specified HTE assessment a priori, and most (71%) used descriptive methods such as stratification; 21% used statistical tests (e.g., interaction terms in a regression); and no studies used data-driven algorithms. CONCLUSIONS . Although understanding HTEs could enhance policy and practice-based efforts to reduce inequities, it is not routine research practice. Increased evaluation of HTEs across relevant subgroups is needed.
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Affiliation(s)
- Dakota W Cintron
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, Campus Box 0560, San Francisco, CA, 94143, USA
| | - Nancy E Adler
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - Laura M Gottlieb
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - Erin Hagan
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - May Lynn Tan
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - David Vlahov
- Yale School of Nursing at Yale University, 400 West Campus Drive, Room 32306, Orange, CT, 06477, USA
| | - M Maria Glymour
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, Campus Box 0560, San Francisco, CA, 94143, USA
| | - Ellicott C Matthay
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, Campus Box 0560, San Francisco, CA, 94143, USA.
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17
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Eastman MR, Ospina-Romero M, Westrick AC, Kler JS, Glymour MM, Abdiwahab E, Kobayashi LC. Does a Cancer Diagnosis in Mid-to-Later Life Modify Racial Disparities in Memory Aging? Alzheimer Dis Assoc Disord 2022; 36:140-147. [PMID: 35125398 PMCID: PMC9132235 DOI: 10.1097/wad.0000000000000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is unknown whether an incident cancer diagnosis differentially impacts acute and long-term memory aging between older White and Black Americans. METHODS Incident cancer diagnoses and memory (immediate and delayed recall, combined with proxy-reported memory) were assessed at biennial study interviews in the US Health and Retirement Study (N=14,235, 1998-2016). We used multivariable segmented linear mixed-effects models to evaluate the rate of change in standardized memory score (SD/decade) in the years before, acutely at the time of, and in the years following an incident cancer diagnosis, compared to cancer-free adults, by race. RESULTS Black participants experienced faster memory decline than White participants (cancer-free group: -1.211 vs. -1.077; P<0.0001). An incident cancer diagnosis was associated with an acute memory drop in White, but not Black participants (-0.065 vs. 0.024; P<0.0001). However, White cancer survivors experienced slower memory decline than cancer-free White adults before and after diagnosis, but this memory advantage was not observed among Black cancer survivors. CONCLUSIONS Racial disparities in memory aging are not modified by an incident cancer diagnosis. The acute cancer-related memory decline and long-term memory advantage experienced by White, but not Black, cancer survivors relative to cancer-free older adults, requires further investigation.
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Affiliation(s)
- Marisa R. Eastman
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI
| | - Monica Ospina-Romero
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ashly C. Westrick
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI
| | - Jasdeep S. Kler
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI
| | - Medellena Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Ekland Abdiwahab
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Lindsay C. Kobayashi
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI
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18
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Rapid health impact assessment of a Danish policy document: One Denmark without Parallel Societies: No Ghettos in 2030. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01375-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Johnson-Agbakwu CE, Ali NS, Oxford CM, Wingo S, Manin E, Coonrod DV. Racism, COVID-19, and Health Inequity in the USA: a Call to Action. J Racial Ethn Health Disparities 2022; 9:52-58. [PMID: 33197038 PMCID: PMC7668281 DOI: 10.1007/s40615-020-00928-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
The current national COVID-19 mortality rate for Black Americans is 2.1 times higher than that of Whites. In this commentary, we provide historical context on how structural racism undergirds multi-sector policies which contribute to racial health inequities such as those highlighted by the COVID-19 pandemic. We offer a concrete, actionable path forward to address structural racism and advance health equity for Black Americans through anti-racism, implicit bias, and cultural competency training; capacity building; community-based participatory research (CBPR) initiatives; validated metrics for longitudinal monitoring of efforts to address health disparities and the evaluation of those interventions; and advocacy for and empowerment of vulnerable communities. This necessitates a multi-pronged, coordinated approach led by clinicians; public health professionals; researchers; social scientists; policy-makers at all governmental levels; and local community leaders and stakeholders across the education, legal, social service, and economic sectors to proactively and systematically advance health equity for Black Americans across the USA.
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Affiliation(s)
- Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center (SIRC), Arizona State University, Phoenix, AZ, USA.
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, USA.
- Creighton University School of Medicine, Phoenix, AZ, USA.
- District Medical Group, Phoenix, AZ, USA.
| | - Nyima S Ali
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Creighton University School of Medicine, Phoenix, AZ, USA
- District Medical Group, Phoenix, AZ, USA
| | - Corrina M Oxford
- Maternal Fetal Medicine/Critical Care Medicine, NewYork-Presbyterian Hospital, Clinical Obstetrics and Gynecology-Weill Cornell Medical College, Cornell University, New York City, NY, USA
| | | | - Emily Manin
- Southwest Interdisciplinary Research Center (SIRC), Arizona State University, Phoenix, AZ, USA
| | - Dean V Coonrod
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Creighton University School of Medicine, Phoenix, AZ, USA
- District Medical Group, Phoenix, AZ, USA
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20
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Jehn A. The relationship between postsecondary education and adult health behaviors. SSM Popul Health 2022; 17:100992. [PMID: 35036513 PMCID: PMC8749134 DOI: 10.1016/j.ssmph.2021.100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/16/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022] Open
Abstract
Nearly 80% of American adults between the ages of 33-44 have at least some postsecondary education, which ranges from vocational training to a doctorate or professional degree. However, in education-health studies, postsecondary credentials are often grouped into a limited number of categories. This is an important omission as it obscures differentiations between the various types of postsecondary credentials. This study provides the first comprehensive analysis of disparities in health behaviors across detailed levels of postsecondary education. Data comes from Wave 5 of the 2018 National Longitudinal Study of Adolescent to Adult Health (Add Health). A covariance-weighting technique is used to produce behavioral index scores that identify the full spectrum of health behaviors influenced by postsecondary educational attainment. Estimates are initially produced in aggregate for the total sample population, with interaction models subsequently being used to test differences across gender and race/ethnicity population subgroups. The aggregate results indicate that adults with at least a bachelor's degree exhibit healthier lifestyles; however, no difference is observed among adults with lower-level postsecondary credentials, compared to high school graduates. Women experience steeper gradients at higher levels of postsecondary education, compared to men. Both White and Hispanic American adults exhibit comparable health lifestyles across levels of postsecondary education; however, Black Americans were found to experience no returns except at the doctorate or professional degree level. These findings have important implications particularly as adults in their thirties and forties continue to exhibit troubling health and mortality trends. Adult health behaviors across detailed levels of postsecondary education. Estimates are provided both in aggregate and by the most influential population subgroups, including gender and race. Significant better health behaviors found among BA graduates and above. Lower or no returns found among sub-BA holders.
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Affiliation(s)
- Anthony Jehn
- University of Western Ontario, Social Science Centre, Room 5225C, 1151 Richmond Street, London, Ontario, N6G 2V4, Canada
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21
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Sialino LD, van Oostrom SH, Wijnhoven HAH, Picavet S, Verschuren WMM, Visser M, Schaap LA. Sex differences in mental health among older adults: investigating time trends and possible risk groups with regard to age, educational level and ethnicity. Aging Ment Health 2021; 25:2355-2364. [PMID: 33222516 DOI: 10.1080/13607863.2020.1847248] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Older women report lower mental health compared to men, yet little is known about the nature of this sex difference. Therefore, this study investigates time trends and possible risk groups. METHOD Data from the Doetinchem Cohort Study (DCS) and the Longitudinal Aging Study Amsterdam (LASA) were used. General mental health was assessed every 5 years, from 1995 to 1998 onwards (DCS, n = 1412, 20-year follow-up, baseline age 55-64 years). Depressive and anxiety symptoms were assessed for two birth cohorts, from 1992/1993 onwards (LASA cohort 1, n = 967, 24-year follow-up, age 55-65 years,) and 2002/2003 onwards (LASA cohort 2, n = 1002, 12-year follow-up, age 55-65 years) with follow-up measurements every 3-4 years. RESULTS Mixed model analyses showed that older women had a worse general mental health (-6.95; -8.36 to 5.53; range 0-100, ∼10% lower), more depressive symptoms (2.09; 1.53-2.63; range 0-60, ∼30% more) and more anxiety symptoms (0.86; 0.54-1.18; range 0-11, ∼30% more) compared to men. These sex differences remained stable until the age of 75 years, where after they decreased due to an accelerated decline in mental health for men compared to women. Sex differences and their course by age were consistent over successive birth cohorts, educational levels and ethnic groups (Caucasian vs. Turkish/Moroccan). CONCLUSION There is a consistent female disadvantage in mental health across different sociodemographic groups and over decennia (1992 vs. 2002) with no specific risk groups.
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Affiliation(s)
- Lena D Sialino
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sandra H van Oostrom
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Susan Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - W M Monique Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Julius Center for Health Services and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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22
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Vable AM, Duarte CDP, Wannier SR, Chan-Golston AM, Cohen AK, Glymour MM, Ream RK, Yen IH. Understanding the benefits of different types and timing of education for mental health: A sequence analysis approach. J Gerontol B Psychol Sci Soc Sci 2021; 79:gbab147. [PMID: 34387339 PMCID: PMC10935480 DOI: 10.1093/geronb/gbab147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Individuals increasingly experience delays or interruptions in schooling; we evaluate the association between these non-traditional education trajectories and mental health. METHODS Using year-by-year education data for 7,501 National Longitudinal Survey of Youth 1979 participants, ages 14-48 (262,535 person-years of education data), we applied sequence analysis and a clustering algorithm to identify educational trajectory groups, incorporating both type and timing to credential. Linear regression models, adjusted for early-life confounders, evaluated relationships between educational trajectories and mental health component scores (MCS) from the 12-item short form instrument at age 50. We evaluated effect modification by race, gender, and race by gender. RESULTS We identified 24 distinct educational trajectories based on highest credential and educational timing. Compared to high school (HS) diplomas, < HS (beta=-3.41, 95%CI:-4.74,-2.07) and general educational development credentials (GEDs) predicted poorer MCS (beta=-2.07,95%CI:-3.16,-0.98). The following educational trajectories predicted better MCS: some college immediately after High School (beta=1.52, 95%CI:0.68,2.37), Associate degrees after long interruptions (beta=1.73, 95%CI:0.27,3.19), and graduate school soon after Bachelor's completion (beta=1.13, 95%CI:0.21,2.06). Compared to White men, Black women especially benefited from educational credentials higher than HS in predicting MCS. CONCLUSIONS Both type and timing of educational credential predicted mental health. Black women's mental higher especially benefited from higher educational credentials.
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Affiliation(s)
- Anusha M Vable
- Department of Family and Community Medicine, University of California San Francisco, USA
| | | | - S Rae Wannier
- Department of Epidemiology and Biostatistics, University of California San Francisco, USA
| | - Alec M Chan-Golston
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California Merced, USA
| | - Alison K Cohen
- Department of Epidemiology and Biostatistics, University of California San Francisco, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, USA
| | - Robert K Ream
- Graduate School of Education, University of California Riverside, USA
| | - Irene H Yen
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California Merced, USA
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Dupuis JB, Bourque J, El Adlouni SE. Odds of Anxiety and Depression Symptoms in School-Aged Children From Official Language Minority Communities. Front Public Health 2021; 9:660041. [PMID: 34249835 PMCID: PMC8261057 DOI: 10.3389/fpubh.2021.660041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this paper is to assess the odds of suffering from anxiety or depression symptoms based on the presence of certain determinants of health for youth living in the province of New Brunswick, Canada, and in two linguistically different Official Language Minority Communities (OLMCs) in the same province. Methods: With a sample of 22,329 students from grades 7 to 12 in the province of New Brunswick, Canada, logistic regressions were performed to assess each determinant of health's effect on symptoms of anxiety and depression. Results: Some social determinants, like family support, social support and food insecurity, were identified as important determinants of mental health status regardless of linguistic group membership or community membership, while other determinants, such as alcohol use, cannabis use and natural environment, were more prominent in one OLMC than the other. Discussion: Social psychology and public health theories are used in an attempt to explain the results. Limitations and recommendations are also brought forward.
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Affiliation(s)
- Jérémie B Dupuis
- Faculté des Sciences de l'éducation, Université de Moncton, Moncton, NB, Canada
| | - Jimmy Bourque
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Salah-Eddine El Adlouni
- Faculté des Sciences, Département de mathématiques et de Statistique, Université de Moncton, Moncton, NB, Canada
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24
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Cohen AK, Ozer EJ, Rehkopf DH, Abrams B. High School Composition and Health Outcomes in Adulthood: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3799. [PMID: 33917294 PMCID: PMC8038652 DOI: 10.3390/ijerph18073799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND A multitude of empirical evidence documents links between education and health, but this focuses primarily on educational attainment and not on characteristics of the school setting. Little is known about the extent to which aggregate characteristics of the school setting, such as student body demographics, are associated with adult health outcomes. METHODS We use the U.S. nationally representative National Longitudinal Survey of Youth 1979 cohort to statistically assess the association between two different measures of high school student composition (socioeconomic composition, racial/ethnic composition) and two different health outcomes at age 40 (self-rated health and obesity). RESULTS After adjusting for confounders, high school socioeconomic composition, but not racial/ethnic composition, was weakly associated with both obesity and worse self-rated health at age 40. However, after adding adult educational attainment to the model, only the association between high school socioeconomic composition and obesity remained statistically significant. CONCLUSIONS Future research should explore possible mechanisms and also if findings are similar across other populations and in other school contexts. These results suggest that education policies that seek to break the link between socioeconomic composition and negative outcomes remain important but may have few spillover effects onto health.
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Affiliation(s)
- Alison K. Cohen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, CA 94158, USA
| | - Emily J. Ozer
- School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA; (E.J.O.); (B.A.)
| | - David H. Rehkopf
- Departments of Epidemiology & Population Health and Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Barbara Abrams
- School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA; (E.J.O.); (B.A.)
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25
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Eng CW, Glymour MM, Gilsanz P, Mungas DM, Mayeda ER, Meyer OL, Whitmer RA. Do the Benefits of Educational Attainment for Late-life Cognition Differ by Racial/Ethnic Group?: Evidence for Heterogenous Treatment Effects in the Kaiser Healthy Aging and Diverse Life Experience (KHANDLE) Study. Alzheimer Dis Assoc Disord 2021; 35:106-113. [PMID: 33044303 PMCID: PMC8176621 DOI: 10.1097/wad.0000000000000418] [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: 04/17/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Educational attainment is associated with late-life cognitive performance and dementia; few studies have examined diverse racial/ethnic groups to assess whether the association differs by race/ethnicity. METHODS We investigated whether the association between educational attainment and cognition differed between White, Black, Asian, and Latino participants in the Kaiser Healthy Aging and Diverse Life Experiences study (n=1348). Covariate-adjusted multivariable linear regression models examined domains of verbal episodic memory, semantic memory, and executive functioning. RESULTS We observed significant effect heterogeneity by race/ethnicity only for verbal episodic memory (P=0.0198), for which any schooling between high school and college was beneficial for White, Asian, and Black participants, but not Latino participants. We found no evidence of heterogeneity for semantic memory or executive function. DISCUSSION With the exception of Latino performance on verbal episodic memory, more education consistently predicted better cognitive scores to a similar extent across racial/ethnic groups, despite likely heterogenous educational and social experiences.
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Affiliation(s)
- Chloe W. Eng
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16 St.,San Francisco, CA 94158, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, Oakland, CA, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16 St.,San Francisco, CA 94158, San Francisco, CA, USA
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, Oakland, CA, USA
| | - Dan M. Mungas
- Department of Neurology, University of California Davis, 4860 Y St., Sacramento, CA 95817, Davis, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California Los Angeles, 650 Charles E. Young Dr. South, 16-035 Center for Health Sciences, Los Angeles, CA 90095, Los Angeles, CA, USA
| | - Oanh L. Meyer
- Department of Neurology, University of California Davis, 4860 Y St., Sacramento, CA 95817, Davis, CA, USA
| | - Rachel A. Whitmer
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, Oakland, CA, USA
- Department of Public Health Sciences, University of California Davis, Medical Sciences 1-C, One Shields Avenue, Davis, CA 95616, Davis, CA, USA
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Vable AM, Duarte CDP, Cohen AK, Glymour MM, Ream RK, Yen IH. Does the Type and Timing of Educational Attainment Influence Physical Health? A Novel Application of Sequence Analysis. Am J Epidemiol 2020; 189:1389-1401. [PMID: 32676653 DOI: 10.1093/aje/kwaa150] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 11/14/2022] Open
Abstract
Nontraditional education trajectories are common, but their influence on physical health is understudied. We constructed year-by-year education trajectories for 7,501 National Longitudinal Survey of Youth 1979 participants aged 14 to 48 years (262,535 person-years of education data from 1979 to 2014). We characterized trajectory similarity using sequence analysis and used hierarchical clustering to group similar educational trajectories. Using linear regression, we predicted physical health summary scores of the participants at age 50 years from the 12-item Short-Form Survey, adjusting for available confounders, and evaluated effect modification by sex, race/ethnicity, and childhood socioeconomic status. We identified 24 unique educational sequence clusters on the basis of highest level of schooling and attendance timing. General education development credentials predicted poorer health than did high school diplomas (β = -3.07, 95% confidence interval: -4.07, -2.07), and bachelor's degrees attained at earlier ages predicted better health than the same degree attained at later ages (β = 1.66, 95% confidence interval: 0.05, 3.28). Structurally marginalized groups benefited more from some educational trajectories than did advantaged groups (e.g., Black vs. White Americans with some college; those of low vs. high childhood socioeconomic status who received an associate's or bachelor's degree). Both type and timing of educational credentials may influence physical health. Literature to date has likely underestimated the impact of educational trajectories on health.
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Cohen AK, Nussbaum J, Weintraub MLR, Nichols CR, Yen IH. Association of Adult Depression With Educational Attainment, Aspirations, and Expectations. Prev Chronic Dis 2020; 17:E94. [PMID: 32857033 PMCID: PMC7478148 DOI: 10.5888/pcd17.200098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Social factors across one’s lifespan may contribute to the relationship between low educational attainment and depression, but this relationship has been understudied. Previous studies assessing the association between educational attainment and depression did not fully account for prior common determinants across the life course and possible interactions by sex or race/ethnicity. It is also unclear whether the link between educational attainment and depression is independent of the role of aspired educational attainment or expected educational attainment. Methods We used generalized linear log link models to examine the association between educational attainment at age 25 and depression at age 40 in the National Longitudinal Survey of Youth 1979 cohort, adjusting for confounders and mediators from childhood, adolescence, and adulthood. Results Members of each educational attainment group were less likely to be depressed at age 40 than those with less education. After adjusting for educational aspirations and educational expectations, the risk ratios became closer to the null. Neither sex nor race/ethnicity interacted with educational attainment. Additionally, low educational expectations in adolescence, but not low educational aspirations, was associated with a higher risk of depression at age 40. Conclusion Our study provides a nuanced understanding of the role of education, educational expectations, and educational aspirations as part of education’s effect on risk of depression after controlling for a thorough set of confounders and mediators. Our findings may help advance the study of social determinants of depression.
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Affiliation(s)
- Alison K Cohen
- Department of Public and Nonprofit Administration, School of Management, University of San Francisco, 2130 Fulton Street, San Francisco, CA, 94117.
| | - Juliet Nussbaum
- School of Public Health, University of California, Berkeley, Berkeley, California
| | | | - Chloe R Nichols
- Department of Public and Nonprofit Administration, School of Management, University of San Francisco, San Francisco, California
| | - Irene H Yen
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, California
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Chandler R, Guillaume D, Tesema N, Paul S, Ross H, Hernandez ND. Social and Environmental Influences on Sexual Behaviors of College Black Women: Within Group Diversity Between HBCU vs. PWI Experiences. J Racial Ethn Health Disparities 2020; 8:852-862. [PMID: 32827124 DOI: 10.1007/s40615-020-00843-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/11/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Black women carry a disproportionate number of new HIV infections in the USA. Studies that have assessed HIV risk perception along with HIV prevention interventions for Black women have primarily focused on Black women of low socioeconomic status. Few studies have assessed HIV risk perceptions and sexual behavior among college-educated Black women of higher socioeconomic status despite their high risk of HIV. College-educated Black women are most likely to acquire HIV while in college, and there has been a marked absence of research assessing the environmental and cultural influences present throughout college-campuses, coupled with evaluating how these factors shape sexual behaviors. We conducted surveys with Black female students attending a historically Black college and Black female students attending a predominately White university, and compared baseline differences in sexual behaviors among both populations. Results showed that for participants attending the historically Black college certain sociocultural elements, such as music and media, had a significantly stronger influence on sexuality and sexual behaviors compared with students attending predominately White universities. The development of future HIV prevention interventions for Black women necessitates an understanding of the diverse microcultures that Black women come from. This research is high priority for college-educated Black women given this population's lack of inclusion in HIV prevention research.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
| | | | - Naomi Tesema
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Henry Ross
- Center for Community Practice, University of Rochester Medical Center, Rochester, NY, USA
| | - Natalie D Hernandez
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
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Gutin I. Educational differences in mortality associated with central obesity: Decomposing the contribution of risk and prevalence. SOCIAL SCIENCE RESEARCH 2020; 90:102445. [PMID: 32825921 PMCID: PMC7443193 DOI: 10.1016/j.ssresearch.2020.102445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/10/2020] [Accepted: 07/08/2020] [Indexed: 06/11/2023]
Abstract
Thousands of preventable deaths are attributed to obesity in the United States. However, the harmfulness of obesity varies across the population; individuals' education determines access to healthful resources and exposure to competing risks, dampening/amplifying obesity-associated mortality risk. Using restricted U.S. National Health and Nutrition Examination Survey data (N = 40,058; 1988-2015), this study estimates educational differences in mortality attributable to central obesity (waist-to-height ratio ≥0.5) - a dangerous form of abdominal adiposity. Over 30% of excess deaths are attributable to central obesity among college-educated adults, compared to 1-10% among their less-educated counterparts. This difference is larger for cardiometabolic-related mortality, as central obesity may explain 60-70% of excess deaths among college-educated adults. Decomposition analyses show differences are driven by greater obesity-associated risk among college-educated adults, rather than prevalence. Policies targeting health disparities should recognize central obesity as a key risk among highly-educated adults, but only one of many encountered by those with less education.
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Affiliation(s)
- Iliya Gutin
- Department of Sociology, University of North Carolina at Chapel Hill, 123 W. Franklin St., Room 2179-C, Chapel Hill, NC, 27516, USA.
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Thyden NH, Schmidt NM, Osypuk TL. The unequal distribution of sibling and parent deaths by race and its effect on attaining a college degree. Ann Epidemiol 2020; 45:76-82.e1. [PMID: 32371043 DOI: 10.1016/j.annepidem.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Examine (1) the distribution of experiencing the death of a parent or sibling (family death) by race/ethnicity and (2) how a family death affects attaining a college degree. METHODS Participants (n = 8984) were from National Longitudinal Survey of Youth 1997 aged 13-17 at baseline in 1997 and 29-32 in 2013. We examined the prevalence of family deaths by age group and race/ethnicity and used covariate-adjusted logistic regression to assess the relationship between a family death and college degree attainment. RESULTS A total of 4.2% of white youth experienced a family death, as did 5.0% of Hispanics, 8.3% of Blacks, 9.1% of Asians, and 13.8% of American Indians (group test P < .001). A family death from ages 13-22 was associated with lower odds of obtaining a bachelor's degree by ages 29-32 (OR = 0.65, 95% CI = 0.50, 0.84), compared with no family death. The effect of a death was largest during college years (age 19-22) (OR = 0.57, 95% CI = 0.39, 0.82). CONCLUSIONS Young people of color are more likely to have a sibling or parent die; and family death during college years is associated with reduced odds of obtaining a college degree. Racial disparities in mortality might affect social determinants of health of surviving relatives, and college policies are a potential intervention point.
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Affiliation(s)
- Naomi Harada Thyden
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis.
| | - Nicole M Schmidt
- Minnesota Population Center, University of Minnesota, Minneapolis
| | - Theresa L Osypuk
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis; Minnesota Population Center, University of Minnesota, Minneapolis
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Matthay EC, Hagan E, Gottlieb LM, Tan ML, Vlahov D, Adler NE, Glymour MM. Alternative causal inference methods in population health research: Evaluating tradeoffs and triangulating evidence. SSM Popul Health 2020; 10:100526. [PMID: 31890846 PMCID: PMC6926350 DOI: 10.1016/j.ssmph.2019.100526] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/04/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
Population health researchers from different fields often address similar substantive questions but rely on different study designs, reflecting their home disciplines. This is especially true in studies involving causal inference, for which semantic and substantive differences inhibit interdisciplinary dialogue and collaboration. In this paper, we group nonrandomized study designs into two categories: those that use confounder-control (such as regression adjustment or propensity score matching) and those that rely on an instrument (such as instrumental variables, regression discontinuity, or differences-in-differences approaches). Using the Shadish, Cook, and Campbell framework for evaluating threats to validity, we contrast the assumptions, strengths, and limitations of these two approaches and illustrate differences with examples from the literature on education and health. Across disciplines, all methods to test a hypothesized causal relationship involve unverifiable assumptions, and rarely is there clear justification for exclusive reliance on one method. Each method entails trade-offs between statistical power, internal validity, measurement quality, and generalizability. The choice between confounder-control and instrument-based methods should be guided by these tradeoffs and consideration of the most important limitations of previous work in the area. Our goals are to foster common understanding of the methods available for causal inference in population health research and the tradeoffs between them; to encourage researchers to objectively evaluate what can be learned from methods outside one's home discipline; and to facilitate the selection of methods that best answer the investigator's scientific questions.
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Affiliation(s)
- Ellicott C. Matthay
- Center for Health and Community, University of California, San Francisco, 3333, California St, Suite, 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, Campus Box 0560, San Francisco, CA, 94143, USA
| | - Erin Hagan
- Center for Health and Community, University of California, San Francisco, 3333, California St, Suite, 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - Laura M. Gottlieb
- Center for Health and Community, University of California, San Francisco, 3333, California St, Suite, 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - May Lynn Tan
- Center for Health and Community, University of California, San Francisco, 3333, California St, Suite, 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - David Vlahov
- Yale School of Nursing at Yale University, 400 West Campus Drive, Room 32306, Orange, CT, 06477, USA
| | - Nancy E. Adler
- Center for Health and Community, University of California, San Francisco, 3333, California St, Suite, 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - M. Maria Glymour
- Center for Health and Community, University of California, San Francisco, 3333, California St, Suite, 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, Campus Box 0560, San Francisco, CA, 94143, USA
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Stallings-Smith S, Ballantyne T. Ever Use of E-Cigarettes Among Adults in the United States: A Cross-Sectional Study of Sociodemographic Factors. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019864479. [PMID: 31328601 PMCID: PMC6647205 DOI: 10.1177/0046958019864479] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
E-cigarette use among adolescents is well-documented, but less is known about adult users of e-cigarettes. The purpose of this study was to examine associations between sociodemographic factors and e-cigarette use in a nationally representative sample of adults in the United States. Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) for years 2015-2016 were analyzed to assess e-cigarette use among 5989 adults aged ≥18 years. Multivariable logistic regression was conducted to examine associations between the sociodemographic exposures of age, sex, race, marital status, education level, employment status, and poverty-income ratio and the outcome of e-cigarette use. The weighted prevalence of ever use of e-cigarettes was 20%. Compared with adults aged ≥55 years, odds of e-cigarette use were 4.77 times (95% confidence interval [CI] = 3.63-6.27) higher among ages 18 to 34 years and 2.16 times (95% CI = 1.49-3.14) higher among ages 35 to 54 years. Higher odds of e-cigarette use were observed among widowed/divorced/separated participants compared with those who were married/living with a partner, among participants with less than high school (odds ratio [OR] = 1.47; 95% CI = 1.08-2.00) or high school/general educational development (GED) education (OR=1.41; 95% CI = 1.12-1.77) compared with those with college degrees/some college, and among those with incomes below the poverty level (OR=1.31; 95% CI = 1.01-1.69) compared with above the poverty level. For non-smokers of conventional cigarettes, higher odds of e-cigarette use were observed among males compared with females, Mexican Americans/Other Hispanics compared with non-Hispanic whites, and non-working participants compared with those who were working. Overall findings indicate that individuals who are widowed/divorced/separated, individuals with lower education, and with incomes below the poverty level are likely to report ever use of e-cigarettes. As increasing evidence demonstrates negative health consequences, e-cigarette initiation may ultimately contribute to additional smoking-related health inequalities even among non-smokers of conventional cigarettes.
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Vable AM, Nguyen TT, Rehkopf D, Glymour MM, Hamad R. Differential associations between state-level educational quality and cardiovascular health by race: Early-life exposures and late-life health. SSM Popul Health 2019; 8:100418. [PMID: 31249857 PMCID: PMC6586990 DOI: 10.1016/j.ssmph.2019.100418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 01/13/2023] Open
Abstract
Cardiovascular diseases (CVD) are patterned by educational attainment but educational quality is rarely examined. Educational quality differences may help explain racial disparities. Health and Retirement Study respondent data (1992-2014; born 1900-1951) were linked to state- and year-specific educational quality measures when the respondent was 6 years old. State-level educational quality was a composite of state-level school term length, student-to-teacher ratio, and per-pupil expenditure. CVD-related outcomes were self-reported (N = 24,339) obesity, heart disease, stroke, ever-smoking, high blood pressure, diabetes and objectively measured (N = 10,704) uncontrolled blood pressure, uncontrolled blood sugar, total cholesterol, high-density lipoprotein cholesterol (HDL), and C-reactive protein. Race/ethnicity was classified as White, Black, or Latino. Cox models fit for dichotomous time-to-event outcomes and generalized estimating equations for continuous outcomes were adjusted for individual and state-level confounders. Heterogeneities by race were evaluated using state-level educational quality by race interaction terms; race-pooled, race by educational quality interaction, and race-specific estimates were calculated. In race-pooled analyses, higher state-level educational quality was protective for obesity (HR = 0.92; 95%CI(0.87,0.98)). In race-specific estimates for White Americans, state-level educational quality was protective for high blood pressure (HR = 0.95; 95%CI(0.91,0.99). Differential relationships among Black compared to White Americans were observed for obesity, heart disease, stroke, smoking, high blood pressure, and HDL cholesterol. In race-specific estimates for Black Americans, higher state-level educational quality was protective for obesity (HR = 0.88; 95%CI(0.84,0.93)), but predictive of heart disease (HR = 1.07; 95%CI(1.01,1.12)), stroke (HR = 1.20; 95%CI(1.08,1.32)), and smoking (HR = 1.05; 95%CI(1.02,1.08)). Race-specific hazard ratios for Latino and Black Americans were similar for obesity, stroke, and smoking. Better state-level educational quality had differential associations with CVD by race. Among minorities, better state-level educational quality was predominately associated with poorer CVD outcomes. Results evaluate the 1900-1951 birth cohorts; secular changes in the racial integration of schools since the 1950s, means results may not generalize to younger cohorts.
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Affiliation(s)
- Anusha M. Vable
- Department of Family and Community Medicine, University of California, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Thu T. Nguyen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - David Rehkopf
- Center for Population Health Sciences, Stanford University, USA
- Department of Medicine, Division of Primary Care and Population Health, Stanford University, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Department of Social and Behavioral Health, Harvard T.H. Chan School of Public Health, Harvard University, USA
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA
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