Are benefits conferred with greater socioeconomic position undermined by racial discrimination among African American men?

Discrimination in Medical Settings across Populations: Evidence From the All of Us Research Program

INTRODUCTION

Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations.

METHODS

Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023-2024.

RESULTS

About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05.

CONCLUSIONS

The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the healthcare system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing healthcare disparities.

Accumulation of perceived discrimination over time and likelihood of probable mental health problems in UK adults: A longitudinal cohort study

BACKGROUND

Limited research has examined whether accumulation of discrimination over time is associated with worse mental health and whether such experiences are related to socioeconomic status (SES).

METHODS

A sample of UK adults with self-reported discrimination experiences (n = 3863) was taken from three waves of the UK Household Longitudinal Study (2015-2020). Multinomial logistic regression assessed associations between SES (income, education, occupation) and cumulative discrimination (number of timepoints discrimination was reported). Logistic regression models assessed prospective associations between cumulative discrimination and probable mental health problems (GHQ-12; 4+ threshold).

RESULTS

Those with lower income were more likely to report discrimination at one timepoint (vs. none). No SES measures were associated with experiencing discrimination at multiple timepoints. Participants who reported one timepoint of discrimination (vs. no experiences) were significantly more likely to report probable mental health problems (OR = 1.47, p < .001, 95% CI 1.20-1.80). Moreover, compared to those experiencing one timepoint, participants reporting multiple timepoints of discrimination were significantly more likely to report probable mental health problems (OR = 1.46, p = .002, 95% CI 1.15-1.86), indicating a cumulative association between discrimination and mental health. There was limited evidence that SES moderated this cumulative association.

LIMITATIONS

Mental health measures were based on self-report questionnaires and not a clinical diagnosis.

CONCLUSIONS

Amongst a sample of UK adults, perceiving discrimination at multiple timepoints increased the likelihood of experiencing probable mental health problems. There was limited evidence that this cumulative association differed by SES. National measures designed to reduce discrimination may benefit mental health.

High Systolic Blood Pressure of High-Income African American Children

BACKGROUND

According to the Minorities' Diminished Returns (MDRs) theory, racism may reduce the health returns of family socioeconomic status (SEP) resources such as family income for racial minorities, particularly African Americans, compared to Whites. However, we are unaware of any previous studies on racial variation in the protective effects of family income on children's blood pressure.

AIM

We conducted this study to compare the overall effects of family income on pre-adolescents' systolic and diastolic blood pressure, test racial variation in this effect, and investigate whether racial variation in this regard is due to racial differences in body mass index.

METHODS

In this cross-sectional study, we analyzed data from 4007 racially diverse US children 9-10 years old. The independent variable was family income measured as a three-level categorical variable: less than $50 K USD, 50-100 K USD, and 100 + K USD. The primary outcomes were systolic and diastolic blood pressure measured up to three times at 1-min time intervals. Body mass index was the mediator. Mixed-effects regression models were used for data analysis to adjust for data nested to the centers, families, and individuals. Age, gender, parental education, family structure, and Latino ethnicity were covariates.

RESULTS

In the pooled sample and in the absence of interaction terms in the model, family income did not show an inverse association with children's systolic (for 100 + K USD family income: β =  - 0.71, p = 0.233 and for 50-100 K USD family income: β = 0.01, p = 0.989) or diastolic blood pressure (for 100 + K USD family income: β =  - 0.66, p = 0.172 and for 50-100 K USD family income: β = 0.23, p = 0.600). However, race showed a significant interaction with family income on systolic blood pressure (for 50-100 K USD × African American: β = 2.75, p = 0.034), suggesting higher systolic blood pressure of African American adolescents from high-income backgrounds. Racial variation in the protective effect of family income on systolic BP was no more significant (for 50-100 K USD × African American: β = 2.14, p = 0.149) after we controlled for body mass index (BMI), which was higher for African American than White adolescents.

CONCLUSION

The association between high family income and reduced systolic blood pressure in pre-adolescence might be weaker for African Americans compared to Whites, a difference that African American adolescents' higher body mass index can explain.

Connections between academic motivation and benefits to low-grade inflammatory regulation among the socioeconomically advantaged

INTRODUCTION

Working to reach school goals during adolescence and rise in the socioeconomic hierarchy can have unexpected negative consequences for physical health, which are often linked to inflammation. However, certain forms of academic motivation, like finding meaning in difficulty, can benefit health and well-being. The current study tests whether socioeconomic resources explain this paradox and moderate the relationship between motivational processes and indicators of inflammation among adolescents. Having greater socioeconomic resources may provide the circumstances necessary to experience a beneficial connection between higher school motivation and lower indicators of inflammation.

METHOD

Seventy-nine adolescents in the United States from diverse backgrounds completed a survey and health screening (59.6% girls, Mage = 14). The survey included a key measure of motivation indicating how students respond to experiences of academic difficulty. The health screening produced assays of C-reactive protein and interleukin 6 from antecubital blood samples, which provided an indicator of low-grade inflammation.

RESULTS

Multiple linear regression analyses demonstrated the expected pattern of moderation, such that students with high (but not low) socioeconomic resources experienced a positive connection between motivation and indicators of inflammatory regulation, especially C-reactive protein.

CONCLUSIONS

The findings provide an important contribution to understanding the complex links between achievement and health. Future research on the health costs of mobility should consider the health benefits of motivation that may be observed uniquely among the socioeconomically advantaged. Further, education institutions should promote motivation in ways that are connected to health sustaining forms of support for all students.

Institutional Context Shapes the Physical Health of College Graduates Differently for U.S. White, Black, and Hispanic Adults

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.

Household Income and Subsequent Youth Tobacco Initiation: Minorities' Diminished Returns

Introduction

Household income, a prominent socioeconomic status (SES) indicator, is known to mitigate youth engagement in various health risk behaviors, including tobacco use. Nevertheless, the Minorities' Diminished Returns theory suggests that this protective effect may be less pronounced for racial and ethnic minorities compared to majority groups. This study aimed to investigate the protective role of high household income against tobacco use among youth and explore potential variations across different racial and ethnic groups.

Methods

Conducted as a longitudinal analysis, this study utilized data from the initial three years of the Adolescent Brain Cognitive Development (ABCD) Study spanning 2016-2022. The cohort consisted of 11,875 American youth aged 9-10 years, tracked over a three-year period. The dependent variable was tobacco initiation, irrespective of the product, while household income served as the independent variable. Covariates included youth age, gender, family education, structure, and employment, with race/ethnicity acting as the moderating variable.

Results

Out of the 8,754 American youth who were non-smokers at baseline, 3.1% (n = 269) initiated tobacco use during the 30-month follow-up, while 96.9% (n = 8,485) remained non-smokers. A family income exceeding $100,000 per year was associated with a lower hazard ratio for tobacco initiation (transitioning to ever-use) over the follow-up period (HR = 0.620, p = 0.022). However, household income of $50-100k exhibited significant interactions with race/ethnicity on tobacco initiation, indicating weaker protective effects for Black (HR for interaction = 7.860, p < 0.001) and Latino (HR for interaction = 3.461, p = 0.001) youth compared to non-Latino White youth.

Conclusions

Within the United States, the racialization and minoritization of youth diminish the protective effects of economic resources, such as high household income, against the transition to tobacco use. Non-Latino White youth, the most socially privileged group, experience greater protection from their elevated household income regarding tobacco initiation compared to Black and Latino youth, who face minoritization and racialization. Policymakers should address not only the SES gap but also the mechanisms contributing to the heightened risk of tobacco use among racialized and minoritized youth from affluent backgrounds.

What is Common Becomes Normal; Black-White Variation in the Effects of Adversities on Subsequent Initiation of Tobacco and Marijuana During Transitioning into Adolescence

Background

While adversities across domains of finance, race, family, and life may operate as risk factors for initiation of substance use in adolescents, the influence of these factors may vary across racial groups of youth. Unfortunately, the existing knowledge is minimal about racial differences in the types of adversities that may increase the risk of subsequent substance use initiation during the transition into adolescence.

Aim

To compare racial groups for the effects of adversities across domains of finance, race, family, and life on subsequent substance use initiation among pre-adolescents transitioning into adolescence.

Methods

In this longitudinal study, we analyzed data from 6003 non-Latino White and 1562 non-Latino African American 9-10-year-old children transitioning into adolescence. Data came from the Adolescent Brain Cognitive Development (ABCD) study. Participants were followed for up to thirty-six months as they transitioned to adolescence. The independent variables were adversities related to the domains of finance, race, family, and life. The primary outcomes were time to first tobacco or marijuana use. Age, puberty, and gender were confounders. Cox regression models were used for data analysis.

Results

For White youth, tobacco use was under influence of having two parents in the household (HR = .611; 95% CI = .419-.891), parental education (HR = .900; 95% CI = .833-.972), household income (HR = .899; 95% CI = .817-.990), racial stress (HR = 1.569; 95% CI = 1.206-2.039), and life stress (HR =1.098 ; 95% CI = 1.024-1.178) and marijuana use was under influence of neighborhood income (HR = .576; 95% CI = .332-.999) and financial stress (HR =4.273; 95% CI = 1.280-17.422). No adverse condition predicted tobacco or marijuana use of African American youth.

Conclusion

The effects of adversities on substance use depend on race. While various types of adversities tend to increase subsequent initiation of tobacco and marijuana, such factors may be less influential for African American adolescents, who experience more of such adversities. What is common may become normal.

Intersectional Effects of Race and Educational Attainment on Memory Function of Middle-Aged and Older Adults With Alzheimer's Disease

BACKGROUND

High educational attainment may protect individuals, particularly middle-aged and older adults, against a wide range of health risks, including memory decline with age; however, this protection is less clear in patients with Alzheimer's disease (AD). In addition, this effect may differ across racial groups. According to the Marginalized-Related Diminished Return (MDR) theory, for example, the protective effect of high educational attainment on mental and physical health shows a weaker protective effect for racial minority groups, particularly Black people compared to White individuals.

OBJECTIVES

This longitudinal study used data of middle-aged and older adults with AD with two aims: first, to test the association between educational attainment and memory, and second, to explore racial differences in this association in the USA.

METHODS

Data came from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. The total sample was 1673 American middle-aged and older adults. The independent variable was educational attainment measured as years of education. The main outcome was memory operationalized as Rey Auditory Verbal Learning Test (RAVLT) Verbal Forgetting percentage (VF%). Age, gender, and follow-up duration were covariates. Race was the effect modifier. Linear regression model was utilized to analyze the data.

RESULTS

Of all participants, 68 (4.1%) were Black, and the remaining were White, with a mean age of 75 years old. In the pooled sample, educational attainment did not show a significant association with memory, independent of confounders. Educational attainment showed a significant interaction with race on memory, with higher educational attainment having a different effect on memory in White patients compared to Black patients.

CONCLUSION

The effect of higher educational attainment on memory differs for Black patients with AD compared to White patients. To prevent cognitive disparities by race, we need to go beyond racial inequality in access to resources (e.g., education) and minimize diminished returns of educational attainment for racial minorities. To tackle health inequalities, social policies should not be limited to equalizing socioeconomic status but also help minority groups leverage their available resources, such as educational attainment, and secure tangible outcomes.

Immigration, Educational Attainment, and Subjective Health in the United States

Objectives

Although educational attainment is a major social determinant of health, according to Marginalization-related Diminished Returns (MDRs), the effect of education tends to be weaker for marginalized groups compared to the privileged groups. While we know more about marginalization due to race and ethnicity, limited information is available on MDRs of educational attainment among US immigrant individuals.

Aims

This study compared immigrant and non-immigrant US adults aged 18 and over for the effects of educational attainment on subjective health (self-rated health; SRH).

Methods

Data came from General Social Survey (GSS) that recruited a nationally representative sample of US adults from 1972 to 2022. Overall, GSS has enrolled 45,043 individuals who were either immigrant (4,247; 9.4%) and non-immigrant (40,796; 90.6%). The independent variable was educational attainment, the dependent variable was SRH (measured with a single item), confounders were age, gender, race, employment and marital status, and moderator was immigration (nativity) status.

Results

Higher educational attainment was associated with higher odds of good SRH (odds ratio OR = 2.08 for 12 years of education, OR = 2.81 for 13-15 years of education, OR = 4.38 for college graduation, and OR = 4.83 for graduate studies). However, we found significant statistical interaction between immigration status and college graduation on SRH, which was indicative of smaller association between college graduation and SRH for immigrant than non-immigrant US adults.

Conclusions

In line with MDRs, the association between educational attainment and SRH was weaker for immigrant than non-immigrant. It is essential to implement two sets of policies to achieve health inequalities among immigrant populations: policies that increase educational attainment of immigrants and those that increase the health returns of educational attainment for immigrants.

Exposure to Adverse Life Events among Children Transitioning into Adolescence: Intersections of Socioeconomic Position and Race

Background

Racism is shown to diminish the protective effects of family socioeconomic position (SEP) resources for racial minorities compared to the majority groups, a pattern called minorities' diminished returns. Our existing knowledge is minimal about diminished returns of family SEP indicators on reducing exposure to adverse life events among children transitioning into adolescence.

Aim

To compare diverse racial groups for the effects of family income and family structure on exposure to adverse life events of pre-adolescents transitioning to adolescence.

Methods

In this longitudinal study, we analyzed data from 22,538 observations belonging to racially diverse groups of American 9-10-year-old children (n = 11,878) who were followed while transitioning to adolescence. The independent variables were family income and family structure. The primary outcome was the number of stressful life events with impact on adolescents, measured by the Life History semi-structured interview. Mixed-effects regression models were used for data analysis to adjust for data nested to individuals, families, and centers.

Results

Family income and married family structure had an overall inverse association with children's exposure to adverse life events during transition to adolescence. However, race showed significant interactions with family income and family structure on exposure to adverse life events. The protective effects of family income and married family structure were weaker for African American than White adolescents. The protective effect of family income was also weaker for mixed/other race than White adolescents.

Conclusion

While family SEP is protective against children's exposure to adverse life events, this effect is weaker for African American and mixed/other race compared to White youth.

Allostatic load in the US general population: Race and educational intersection

Objectives

Educational attainment is a protective factor against poor health, but high educational attainment has a weaker effect on black people than on white people; this pattern has been called marginalization-related diminished returns (MDRs). Using a national sample of white people and black people 25 years and above, this study estimates the association between high educational attainment and allostatic load between black people and white people, and within each group.

Study design

This cross-sectional study uses data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016, including 2761 black people and 7058 white people. The outcome variable of interest was the Allostatic Load Scale (AL). We created the allostatic load scale by using 8 biomarkers, then created a binary variable (if ALS≥4 as 1 and ALS<4 as 0) to present elevated AL.

Methods

We used several weighted modified Poisson regression models controlling for educational attainment (a predictor) and race (a moderator variable), age, sex, and marital status. We also controlled the models for smoking and drinking status as health behavior variables. As a sensitivity analysis, we ran several sets of regression analysis using the AL scale as a continuous outcome variable.

Results

We found an inverse association between AL and educational attainment. The interaction between race and education has resulted in an inverse association between AL and educational attainment, with a weaker association in black people than in white people. We found similar findings by running regression models with AL as a continuous variable.

Conclusions

We observed a weaker association between educational attainment and AL in black people than in white people, suggesting that educational attainment has more robust protection against allostatic load for white people than black people.

Instrumental Variable Analysis of Racial Discrimination and Blood Pressure in a Sample of Young Adults

Racial inequities in blood pressure levels have been extensively documented. Experiences of racial discrimination could explain some of this disparity, although findings from previous studies have been inconsistent. To address limitations of prior literature, including measurement error, we implemented instrumental variable analysis to assess the relationship between racial discrimination in institutional settings and blood pressure. Using data from 3,876 Black and White adults with an average age of 32 years from examination 4 (1992-1993) of the Coronary Artery Risk Development in Young Adults Study, our primary analysis examined the relationship between self-reported experiences of racial discrimination in institutional settings and blood pressure using reflectance meter measurement of skin color as an instrument. Findings suggested that an increase in experiences of racial discrimination was associated with higher systolic and diastolic blood pressure (β = 2.23 mm Hg (95% confidence interval: 1.85, 2.61) and β = 1.31 (95% confidence interval: 1.00, 1.62), respectively). Our instrumental variable estimates suggest that experiences of racial discrimination within institutional settings contribute to racial inequities in elevated blood pressure and cardiovascular disease outcomes in a relatively young cohort of adults and may yield clinically relevant differences in cardiovascular health over the life course.

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)

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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Key Words

• African Americans
• cognition
• depression
• discrimination
• education
• psychosocial stress

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MESH Headings

• Aged
• Humans
• Black or African American
• Cognition
• Depression/psychology
• Educational Status
• Healthy Aging
• Racism/ethnology
• Racism/psychology

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Grants

• R01 AG066132 NIA NIH HHS
• R01 AG050782 NIA NIH HHS
• RF1 AG050782 NIA NIH HHS
• P30 AG072972 NIA NIH HHS
• R00 AG073457 NIA NIH HHS

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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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Racial discrimination, childhood adversity, and depression among Black men: Tests of stress sensitization hypotheses

Racial discrimination has been linked to depression among Black American men. Racial discrimination, however, does not uniformly confer risk for depression. According to the stress sensitization theory, racial discrimination can be particularly harmful for those with histories of adversity in childhood. Existing research on stress sensitization is limited in that it has conceptualized childhood adversity as a unidimensional construct composed of a broad range of stressful experiences. To fill this gap in the literature, the current study investigated stress sensitization hypotheses, focusing on how different dimensions of adverse childhood experiences moderate the association between racial discrimination and depression. Study sample was 504 young Black men (mean age at baseline = 20.3, SD = 1.08) living in rural counties in South Georgia where childhood adversity is disproportionately high. The association between racial discrimination and increased risk for depressive symptoms varied by the degree of childhood experience of deprivation, but not threat. Our findings suggest that no or low levels of childhood deprivation, which is commonly regarded as a protective factor, can elevate the negative effects of discrimination on depression. This finding emphasizes that clinicians should consider developmental risk and protective factors that are unique to Black American men.

Daily discrimination, church support, personal mastery, and psychological distress in black people in the United States

OBJECTIVE

This study used the stress process model to test the mediating effects of personal mastery and moderating effects of church-based social support on the relationship between daily discrimination and psychological distress across three age groups of African American and Afro-Caribbean adults.

METHODS

Using a national sample of 5008 African Americans and Afro-Caribbean adults from the National Survey of American Life Study, this study employs structural equation modeling to investigate the relationships between daily discrimination, personal mastery, church-based social support, and psychological distress.

RESULTS

Daily discrimination was an independent predictor of psychological distress across all groups. Group- and age-specific comparisons revealed significant differences in the experience of daily discrimination and psychological distress. Mastery was a partial mediator of the relationship between discrimination and psychological distress among Afro-Caribbeans while church support was a significant moderator only among the young and older African Americans.

IMPLICATIONS

Together, our study findings provide useful first steps towards developing interventions to reduce the adverse psychological impacts of daily discrimination on African Americans and Afro-Caribbeans. Intervention efforts such as individual psychotherapy aimed to improve Afro-Caribbean individuals' sense of mastery would be a partial solution to alleviating the adverse effects of discrimination on their psychological health.

Prevalence of perceived discrimination and associations with mental health inequalities in the UK during 2019-2020: A cross-sectional study

Experiencing discrimination is associated with poorer mental health and the demographic patterning of discrimination may explain social inequalities in mental health. The present research examined prevalence of perceived discrimination in the UK and associations with social inequalities in mental health. Data were taken from the UK Household Longitudinal Study (n = 32,003). Population subgroups (sex, age, ethnicity, health, religiousness, income, education, and occupation), perceived personal discrimination (personal experience) and perceived belonging to a discriminated group (identified as belonging to a group discriminated against in this country), and probable mental health problems (GHQ-12 assessed, cut off 4+) were reported on in 2019/2020. Nineteen percent of participants perceived personal discrimination in the last year, 9% perceived belonging to a discriminated group, and 22% had probable mental health problems. There were significant inequalities in both perceived discrimination and mental health. Being a younger adult, of mixed ethnicity, having health problems, having a university degree, and being unemployed increased risk of mental health problems and these associations were partially explained by perceived discrimination being more common among these groups. Perceived discrimination is common among UK adults, but prevalence differs by population subgroup. Perceived discrimination may contribute to social inequalities in mental health.

Psychological Well-being across the Perinatal Period: Life Satisfaction and Flourishing in a Longitudinal Study of Black and White American Women

Psychological well-being (life satisfaction and flourishing) during the perinatal period has implications for both maternal and child health. However, few studies have investigated the extent to which psychological well-being changes from preconception to postpartum periods, particularly among diverse samples of women. Using prospectively collected data from an ongoing longitudinal study, we investigated changes in two dimensions of psychological well-being from preconception to postpartum among 173 Black and White American women. Results showed that changes in life satisfaction (i.e., global quality of life) and flourishing (e.g., self-acceptance, sense of purpose) over the perinatal period were moderated by race. For life satisfaction, White women reported an increase from preconception to pregnancy with increased life satisfaction levels remaining stable from pregnancy to postpartum. However, Black women reported no changes in life satisfaction across these timepoints. In contrast, both Black and White women reported an increase in flourishing levels across the perinatal period, although the timing of these changes differed. Findings highlight a need for greater clinical and empirical attention to the way in which psychological well-being changes during the perinatal period to optimize health and inform strengths-based intervention targets.

The Relationship between Religion, Substance Misuse, and Mental Health among Black Youth

Studies suggest that religion is a protective factor for substance misuse and mental health concerns among Black/African American youth despite reported declines in their religious involvement. However, few studies have investigated the associations among religion, substance misuse, and mental health among Black youth. Informed by Critical Race Theory, we evaluated the correlations between gender, depression, substance misuse, and unprotected sex on mental health. Using multiple linear regression, we assessed self-reported measures of drug use and sex, condom use, belief in God, and religiosity on mental health among a sample of Black youth (N = 638) living in a large midwestern city. Results indicated drug use, and sex while on drugs and alcohol, were significant and positively associated with mental health symptoms. Belief in God was negatively associated with having sex while on drugs and alcohol. The study's findings suggest that despite the many structural inequalities that Black youth face, religion continues to be protective for Black youth against a myriad of prevalent problem behaviors.

Understanding the Impact of Contemporary Racism on the Mental Health of Middle Class Black Americans

Evidence from previous research indicates that while socioeconomic status (SES) narrows Black-White health inequities, these inequities do not completely disappear, and in some cases, worsen. Why do Black-White health inequities persist, even when controlling for SES? It is critical to examine how perceptions of unfair treatment, especially those that are nuanced and subtle, affect the mental health of Black Americans with greater levels of SES. This study, using a new sample composed exclusively of college-educated Black Americans, investigated whether experiences related to racism were associated with poorer mental health. Qualtrics provided the sample from their nationwide panelists that met the research criteria. Inclusion criteria included the following: (1) self-identified as Black or African American; (2) at least 24 years old; (3) completed a 4-year college degree or higher. The findings from this study indicated that the effects of unfair treatment are significantly associated with poorer mental health. These findings highlight the insidious nature of contemporary racism as the everyday experiences of unfair treatment have a tremendous effect on depressive symptoms among this sample of college-educated Black Americans. Efforts to simply improve SES among historically marginalized groups will not bring about health equity. Findings from this study indicate that there are mental health costs associated with upward social mobility. It is likely that these costs, particularly the experience of everyday unfair treatment, likely diminish the social, economic and health returns on the human capital.

Testing the Associations Between State and Trait Anxiety, Anger, Sadness, and Ambulatory Blood Pressure and Whether Race Impacts These Relationships

BACKGROUND

Anxiety, anger, and sadness are related to elevated ambulatory blood pressure (ABP), yet it is unclear whether each emotion exerts unique effects. Moreover, an understanding of who might be most susceptible to the negative effects of these emotions is limited, with the trait tendency to experience them or one's race as potential moderators.

PURPOSE

The study examined the potential for differential effects of momentary anxiety, anger, and sadness on ABP. The study assessed whether a trait tendency to experience these negative emotions and/or race (Black vs. non-Black) would moderate these relationships.

METHODS

Participants (n = 153) completed trait anxiety, anger, and depressive symptoms measures at baseline. ABP was collected over two 24-hour periods 3-4 months apart. Momentary measures of anxiety, anger, and sadness were assessed via ecological momentary assessment (EMA) after each ABP reading.

RESULTS

Momentary anxiety consistently predicted diastolic blood pressure but not systolic blood pressure. Momentary anger and sadness did not predict blood pressure (BP). Conditional effects were found with momentary anxiety and anger predicting elevated BP in those individuals with trait anxiety/anger at its mean. Trait anxiety and depression consistently predicted heightened BP in Black participants. Trait anger did not moderate the relationships between negative emotions and ABP.

CONCLUSIONS

Findings suggest that momentary anxiety and anger should be given attention as potential risk factors for hypertension and highlight the unique perspective of EMA methods. Black participants who were more anxious and depressed experienced heightened BP, with anxiety and depression providing possible intervention targets in improving racial disparities in cardiovascular health.

Social Determinants of Mental, Physical, and Oral Health of Middle-Aged and Older African Americans in South Los Angeles

BACKGROUND

A growing body of research suggests that financial difficulties could weaken the protective effects of socioeconomic status (SES) indicators, including education and income, on the health status of marginalized communities, such as African Americans.

AIM

We investigated the separate and joint effects of education, income, and financial difficulties on mental, physical, and oral self-rated health (SRH) outcomes in African American middle-aged and older adults.

METHODS

This cross-sectional study enrolled 150 middle-aged and older African Americans residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics (education, income, and financial difficulties), and self-rated health (mental, physical, and oral health) were collected. Three linear regression models were used to analyze the data.

RESULTS

Higher education and income were associated with a lower level of financial strain in a bivariate analysis. However, according to multivariable models, only financial difficulties were associated with poor mental, physical, and oral health. As similar patterns emerged for all three health outcomes, the risk associated with financial difficulties seems robust.

CONCLUSIONS

According to our multivariable models, financial strain is a more salient social determinant of health within African American communities than education and income in economically constrained urban environments such as South Los Angeles. While education and income lose some protective effects, financial strain continues to deteriorate the health of African American communities across domains.

Immigration Status, Socioeconomic Status, and Self-Rated Health in Europe

The literature has established a protective effect of socioeconomic status (SES) indicators on health. However, at least in the US, these SES indicators tend to generate fewer health gains for marginalized groups including immigrants. As this literature mainly originated in the US, it is necessary to study whether these indicators similarly correlate with the health of foreign-born and native-born individuals in Europe. The current study was based on the Marginalization-related Diminished Returns (MDRs) theory and compared the effects of three SES indicators, namely parental education, own education and income, on self-rated health (SRH) of immigrant and native-born individuals. We used data from the European Social Survey 2020 (ESS 2020). Participants included 14,213 individuals who identified as either native-born (n = 9052) or foreign-born (n = 508). Education, income, and parental education were the independent variables. Self-rated health (SRH) was the outcome. Age and sex were covariates. Linear regression and logistic regression were used for data analysis. Overall, high education, income, and parental education were associated with lower odds of poor SRH. We documented a statistical interaction between immigration status and parental education, indicating a weaker inverse association between parental education and poor SRH for foreign-born than native-born individuals. The links between some but not all SES indicators vary across foreign-born and native-born individuals in Europe. Host countries seem to undervalue the parental educational attainment of foreign-born families. Future research should explore the role of time, period, cohort and country of origin as well as host country and associated policies in equalizing returns of SES indicators on the health of population subgroups. The results are important given that most studies on MDRs are developed in the US, and less is known about Europe. The results are also very important given the growing anti-immigrant sentiment and nationalist movements in Europe and the rest of the world.

Prevalence and Effects of Daily and Major Experiences of Racial Discrimination and Microaggressions among Black Individuals in Canada

The prevalence and correlates of different forms of racial discrimination among Black Canadians are unknown. This article aims to examine the prevalence of different forms of racial discrimination (daily, major and microaggressions) and their association with self-esteem and satisfaction with life among Black Canadians. A convenience sample of 845 Black Canadians aged 15-40 was recruited. We assessed frequencies of everyday and major racial discrimination, and racial microaggressions against Black Canadians and their association with self-esteem and satisfaction with life, controlling for gender, age, job status, education, and matrimonial status. At least 4 out of 10 participants declared having being victims of everyday racial discrimination at least once per week. Between 46.3% and 64.2% of participants declared having been victims of major racial discrimination in various situations including education, job hiring, job dismissal, health services, housing, bank and loans, and police encounters. Significant gender differences were observed for everyday and major racial discrimination with higher frequencies among female participants. A total of 50.2% to 93.8% of participants declared having been victims of at least one episode of racial microaggressions. Results showed a significant negative association between racial discrimination and satisfaction with life (b = -0.26, p = .003), and self-esteem (b = -0.23, p = .009). This study highlights the need to stop colorblind policies in different sectors in Canada, and for a public commitment to combat racism at the municipal, provincial and federal levels. Implications are discussed for prevention, research and public health.

Is educational mobility harmful for health?

"Mobility effects" research to date provides mixed evidence about the health consequences of social mobility and pays limited attention to race differences in mobility effects. To address this gap in the literature, this study explores the association between downward mobility and upward mobility with health and how these associations vary between Black people and White people. Diagonal reference models are used to estimate the effects of intergenerational educational mobility on self-rated health and mortality using data from the U.S. General Social Survey (1972-2016) with linked mortality records (1978-2014). Results show that downward mobility is associated with worse self-rated health and higher mortality risk. Downward mobility appears more damaging to the health of White people relative to Black people. Upward mobility appears less beneficial to the health of Black people. These findings indicate that social mobility itself is consequential for health and suggest that downward mobility is detrimental to health.

Association of area-level socioeconomic status and non-small cell lung cancer stage by race/ethnicity and health care-level factors: Analysis of the National Cancer Database

BACKGROUND

This study examined whether the association of socioeconomic status (SES) and non-small cell lung cancer (NSCLC) stage varied by race/ethnicity and health care access measures.

METHODS

This study used data from the 2004-2016 National Cancer Database for patients aged 18-89 years who had been diagnosed with Stage 0-IV NSCLC. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for the associations of area-level SES with an advanced stage at diagnosis via multilevel, multivariable logistic regression. The stage at diagnosis was dichotomized into early (0-II) and advanced (III-IV) stages, and area-level SES was categorized on the basis of the patient's zip code level: (1) the proportion of adults aged ≥25 years without a high school degree and (2) the median household income. The models were stratified by race/ethnicity (non-Hispanic [NH] White, NH Black, Hispanic, Asian, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander), insurance status (none, government, and private), and health care facility type (community, comprehensive community, academic/research, and integrated network).

RESULTS

The study population included 1,329,972 patients. Although only 17% of the NH White patients were in the lowest income quartile, 50% of the NH Black patients were in this group. Lower area-level education and income were associated with higher odds of an advanced-stage diagnosis (aOR for education, 1.12; 95% CI, 1.10-1.13; aOR for income, 1.13; 95% CI, 1.11-1.14). These associations persisted among NH White, NH Black, Hispanic, and Asian patients; among those with government and private insurance (but not the uninsured); and among those treated at each facility type.

CONCLUSIONS

Area-level income and education are strongly associated with an advanced NSCLC diagnosis regardless of the facility type and among those with government and private insurance.

When Resilience Becomes Risk: A Latent Class Analysis of Psychosocial Resources and Allostatic Load Among African American Men

There is a well-established link between psychosocial risks and psychological health among African American (AA) men. Yet, the psychosocial sources and physical health consequences of resilience (i.e., the ability to maintain good health despite adversity) remain underexplored. Using data from 283 AA men in the Nashville Stress and Health Study, the present study investigated the links between psychosocial resilience and allostatic load (AL), a biological indicator of physiological dysregulation. Latent class analysis (LCA) identified distinct resilience profiles comprising eight psychosocial resources across four categories: coping strategies, sense of control, racial identity, and social support. Analysis of variance (ANOVA) tests determined significant class differences in men's AL scores. LCA results confirm a four-class model was the best fit: Class 1 (high resources, 32%), Class 2 (high coping but low control, 13%), Class 3 (low resources but high racial identity, 20%), and Class 4 (low resources but high mastery, 34%). Results reveal lower AL (better health) among Classes 1 (m = 0.35) and 4 (m = 0.31) and higher AL (worse health) among Classes 2 (m = 0.44) and 3 (m = 0.44). Findings indicate that the "quality" rather than the "quantity" of psychosocial resources matters for physical health among AA men, as positive health outcomes were observed among both low- and high-resource classes. Results suggest different resource combinations produce distinct patterns of resilience among AA men and underscore the need to further elucidate complex resilience processes among this population.

Allostatic Load, Income, and Race Among Black and White Men in the United States

Research indicates that income is significantly associated with allostatic load (AL) and that this association may differ between White and Black Americans. Most existing income–AL link work focuses on women and less is known about this association among men. Using data from the National Health and Nutrition Examination Survey (NHANES), we examined whether race moderates the association between income and AL among Black and White men in the United States (n = 5,685). We find that, regardless of income levels, Black men have significantly higher prevalence of being in the high-AL group compared with high-income White men. Our findings suggest that Black men do not receive the same health benefits for increased income relative to their White counterparts.

Contextualizing Educational Disparities in Health: Variations by Race/Ethnicity, Nativity, and County-Level Characteristics

Educational disparities in health are well documented, yet the education-health relationship is inconsistent across racial/ethnic and nativity groups. These inconsistencies may arise from characteristics of the early life environments in which individuals attain their education. We evaluate this possibility by investigating (1) whether educational disparities in cardiometabolic risk vary by race/ethnicity and nativity among Black, Hispanic, and White young adults; (2) the extent to which racial/ethnic-nativity differences in the education-health relationship are contingent on economic, policy, and social characteristics of counties of early life residence; and (3) the county characteristics associated with the best health at higher levels of education for each racial/ethnic-nativity group. Using data from the National Longitudinal Study of Adolescent to Adult Health, we find that Black young adults who achieve high levels of education exhibit worse health across a majority of contexts relative to their White and Hispanic counterparts. Additionally, we observe more favorable health at higher levels of education across almost all contexts for White individuals. For all other racial/ethnic-nativity groups, the relationship between education and health depends on the characteristics of the early life counties of residence. Findings highlight place-based factors that may contribute to the development of racial/ethnic and nativity differences in the education-health relationship among U.S. young adults.

Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research

Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.

Strengths despite stress: Social-structural stressors and psychosocial buffers of depressive symptoms among U.S. Black men

We examined the association between social-structural stressors-racial discrimination, incarceration, and unemployment-and depressive symptoms among 578 predominantly low-income urban Black men, ages 18-45. We also examined the extent to which two protective factors-social support and problem-solving coping-moderated the relationship between social-structural stressors and depressive symptoms. Results showed that more everyday racial discrimination and incarceration, but not unemployment, significantly predicted more depressive symptoms. The links between discrimination, incarceration, and depressive symptoms were stronger for men who reported lower levels of problem-solving coping and social support than those with higher levels. Our study suggests that interventions emphasizing protective factors may help Black men cope with some of the deleterious effects of racial discrimination and incarceration. It also underscores a need for structural interventions that reduce racial discrimination and incarceration. Depression among Black men is not simply a biomedical or psychological condition, but also a critical health equity issue. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prevalence and correlates of depression among Black individuals in Canada: The major role of everyday racial discrimination

BACKGROUND

Depression is a common mental health problem causing significant disability globally, including in Canada. Prevalence estimates for depression within Black communities in Canada are unknown. This study determined the prevalence of depression in a sample of Black Canadians and the association between everyday racial discrimination experiences and depression.

METHODS

We analyzed data collected from the Black Community Mental Health project in Canada. Participants provided sociodemographic information and completed measures assessing depressive symptomology, everyday racial discrimination, and social support. The prevalence of depressive symptomatology was computed across sociodemographic variables and categories of everyday racial discrimination. Different regression models were conducted to examine the relationship between depressive symptoms and everyday racism controlling for sociodemographic factors.

RESULTS

In total, 65.87% of participants reported severe depressive symptoms, with higher rates among women, those who are employed, and those born in Canada. The linear regression models showed that everyday racial discrimination is the best predictor of depressive symptoms, with a final model explaining 25% of the variance. A logistic regression model demonstrated that those experiencing a high level of racial discrimination are 36.4 more likely to present severe depressive symptoms when compared to those reporting a low level of discrimination.

CONCLUSIONS

Rates of depressive symptoms among Black individuals are nearly six times the 12-month prevalence reported for the general population in Canada. Racial discrimination, which significantly predicts greater depressive symptomatology, is consistent with earlier studies in the United States and suggests that Canadian colorblind policies may inadvertently reinforce racial discrimination with detrimental effects on mental health.

The effect of racial discrimination on mental and physical health: A propensity score weighting approach

RATIONALE

The preponderance of research documents the negative consequences of racial discrimination for the mental and physical well-being across several racial/ethnic groups including Black Americans, Hispanic Americans, and Asian Americans. Despite this large body of research, few studies have attempted to evaluate racial discrimination as a casual factor of worse health among racial minority groups. The current study utilized nationally representative data to estimate the causal effect of racial discrimination on cardiovascular disease (CVD), self-rated physical health (SRH), body mass index (BMI), depression disorder, and substance use disorder. In addition, we examined whether the effect of racial discrimination on health was moderated by socio-demographic characteristics (i.e., age, race/ethnicity, sex, socioeconomic status, marital status, geographic location, and health insurance coverage).

METHODS

Data were from the combined National Survey of American Life and the National Latino and Asian American Study. We applied a propensity score weighting approach to estimate the differences between individuals who reported ever (N = 4358) or never (N = 1836) experiencing racial discrimination on a list of health outcomes (e.g., CVD, SRH, BMI, depression disorder, and substance use disorder).

RESULTS

Participants who reported ever experiencing racial discrimination were about 5 % higher CVD risk, had 0.12 points lower SRH, a 3 % higher probability of a depression disorder, and a 2 % higher probability of a substance use disorder. Moderation effects by race/ethnicity, sex, socioeconomic status, geographic region, and health insurance coverage were found.

CONCLUSION

Our study represents one of the first attempts to apply a propensity score weighting approach to causally link racial discrimination to worse health for racial minority individuals. This study adds to a larger body of research documenting the negative association between racial discrimination and health.

Seeking Just Us: A Mixed Methods Investigation of Racism-Specific Support Among Black College Students

Social support is theorized to protect health against the negative effects of stress. However, findings are mixed regarding whether social support protects Black people’s psychological well-being against racism. The current mixed methods study examined racism-specific support (RSS)—social support in response to racism—in same- (Black/Black) and cross-race (Black/non-Black) friendships. We investigated whether 31 Black college students ( M age = 19.7, SD = 1.70; 74% women) had (1) racial preferences (same-vs. cross-race) for whom they sought RSS, and (2) whether perceptions of RSS’s helpfulness differed when provided by cross-race friends. Participants completed measures of emotional closeness to same- and cross-race friends and participated in focus group interviews discussing racism and RSS. Results found participants reported more emotional closeness to Black friends and non-Black friends of color relative to White friends. As predicted, 65% of participants preferred RSS from Black (vs. non-Black) friends. Participants’ qualitative responses ( n = 21–24) revealed Black (vs. non-Black) friends were perceived to better understand racism. These findings suggest RSS from Black friends, specifically, might benefit Black college students’ psychological well-being.

Socio-Demographic and Coping Correlates and Predictors of Depressive Symptoms Among Low-Income and Ethnic Minority Mothers At-Risk

This study identified coping and sociodemographic correlates and predictors of depressive symptoms in mothers at risk for clinical depression. A descriptive, cross-sectional design was employed. A convenience sample of 88 low-income or ethnic-minority mothers aged 21 to 45 completed a depression scale, demographic data sheet, and responded to an open-ended question. Content analysis, descriptive, and inferential statistics was used for data analysis. Exactly 42.5% of mothers reported high depressive symptoms (>16). Lower income levels (r = .342, p = .01) and head-of-household status (r = .220, p = .04) were significantly associated with higher depressive symptoms. Those who used social support coping had lower depressive symptoms than those who did not (t = 2.50, p = .014). Those using emotion-focused coping only had higher depressive symptoms than those using a mix of coping strategies (t = 2.60, p = .011). Healthcare providers can employ vigilant depression screening and encourage utilization of a mix of problem and emotion-focused coping strategies to reduce depressive symptoms and prevent clinical depression.

Social Determinants of Cigarette Smoking among American Women during Pregnancy

Educational attainment is among the most substantial protective factors against cigarette smoking, including during pregnancy. Although Minorities’ Diminished Returns (MDRs) of educational attainment, defined as weaker protective effect of education for racial and ethnic minority groups compared to Non-Hispanic Whites, has been demonstrated in previous studies; such MDRs are not tested for cigarette smoking during pregnancy. To better understand the relevance of MDRs to tobacco use during pregnancy, this study had three aims: firstly, to investigate the association between educational attainment and cigarette smoking in pregnant women; secondly, to compare racial and ethnic groups for the association between educational attainment and cigarette smoking; and thirdly, to explore the mediating effect of poverty status on such MDRs, among American adults during pregnancy. This cross-sectional study explored a nationally representative sample of pregnant American women (n = 338), which was taken from the Population Assessment of Tobacco and Health (PATH; 2013). Current smoking was the outcome. Educational attainment was the independent variable. Region and age were the covariates. Poverty status was the mediator. Race and ethnicity were the effect modifiers. Overall, a higher level of educational attainment (OR = 0.54, p < 0.05) was associated with lower odds of current smoking among pregnant women. Race (OR = 2.04, p < 0.05) and ethnicity (OR = 2.12, p < 0.05) both showed significant interactions with educational attainment on smoking, suggesting that the protective effect of educational attainment against smoking during pregnancy is smaller for Blacks and Hispanics than Non-Hispanic Whites. Poverty status fully mediated the above interactions. In the United States, highly educated pregnant Black and Hispanic women remain at higher risk of smoking cigarettes, possibly because they are more likely to live in poverty, compared to their White counterparts. The results suggest the role that labor market discrimination has in explaining lower returns of educational attainment in terms of less cigarette smoking by racial and ethnic minority pregnant women.

Parents' Perceived Neighborhood Safety and Children's Cognitive Performance: Complexities by Race, Ethnicity, and Cognitive Domain

BACKGROUND AIM

To examine racial/ethnic variations in the effect of parents' subjective neighborhood safety on children's cognitive performance.

METHODS

This cross-sectional study included 10,027 children from the Adolescent Brain Cognitive Development (ABCD) study. The exposure variable was parents' subjective neighborhood safety. The outcomes were three domains of children's cognitive performance: general cognitive performance, executive functioning, and learning/memory. We used mixed-effects regression models for data analysis.

RESULTS

Overall, parents' subjective neighborhood safety was positively associated with children's executive functioning, but not general cognitive performance or learning/memory. Higher parents' subjective neighborhood safety had a more positive influence on the executive functioning of non-Hispanic White than Asian American children. Higher parents' subjective neighborhood safety was associated with higher general cognitive performance and learning/memory for non-White children relative to non-Hispanic White children.

CONCLUSION

The race/ethnicity of children moderates the association between neighborhood safety and cognitive performance. This becomes more complicated, as the patterns seem to differ across race/ethnicity and cognitive domains. It is unknown whether the observed racial/ethnic variations in the effect of neighborhood safety on cognitive performance are due to neighborhood characteristics such as residential segregation. Addressing neighborhood inequalities is needed if we wish to reduce racial/ethnic inequities in the cognitive development of children.

Parental Educational Attainment, the Superior Temporal Cortical Surface Area, and Reading Ability among American Children: A Test of Marginalization-Related Diminished Returns

BACKGROUND

Recent studies have shown that parental educational attainment is associated with a larger superior temporal cortical surface area associated with higher reading ability in children. Simultaneously, the marginalization-related diminished returns (MDRs) framework suggests that, due to structural racism and social stratification, returns of parental education are smaller for black and other racial/ethnic minority children compared to their white counterparts.

PURPOSE

This study used a large national sample of 9-10-year-old American children to investigate associations between parental educational attainment, the right and left superior temporal cortical surface area, and reading ability across diverse racial/ethnic groups.

METHODS

This was a cross-sectional analysis that included 10,817 9-10-year-old children from the Adolescent Brain Cognitive Development (ABCD) study. Parental educational attainment was treated as a five-level categorical variable. Children's right and left superior temporal cortical surface area and reading ability were continuous variables. Race/ethnicity was the moderator. To adjust for the nested nature of the ABCD data, mixed-effects regression models were used to test the associations between parental education, superior temporal cortical surface area, and reading ability overall and by race/ethnicity.

RESULTS

Overall, high parental educational attainment was associated with greater superior temporal cortical surface area and reading ability in children. In the pooled sample, we found statistically significant interactions between race/ethnicity and parental educational attainment on children's right and left superior temporal cortical surface area, suggesting that high parental educational attainment has a smaller boosting effect on children's superior temporal cortical surface area for black than white children. We also found a significant interaction between race and the left superior temporal surface area on reading ability, indicating weaker associations for Alaskan Natives, Native Hawaiians, and Pacific Islanders (AIAN/NHPI) than white children. We also found interactions between race and parental educational attainment on reading ability, indicating more potent effects for black children than white children.

CONCLUSION

While parental educational attainment may improve children's superior temporal cortical surface area, promoting reading ability, this effect may be unequal across racial/ethnic groups. To minimize the racial/ethnic gap in children's brain development and school achievement, we need to address societal barriers that diminish parental educational attainment's marginal returns for middle-class minority families. Social and public policies need to go beyond equal access and address structural and societal barriers that hinder middle-class families of color and their children. Future research should test how racism, social stratification, segregation, and discrimination, which shape the daily lives of non-white individuals, take a toll on children's brains and academic development.

Parental Education and Children’s Sleep Problems: Minorities’ Diminished Returns

Background and aims: While increased parental education reduces children’s sleep problems, less is known about racial variation in such protection. According to Minorities’ Diminished Returns (MDRs) theory, economic resources such as parental education show weaker health effects for minority groups such as Blacks and Latinos than non-Latino Whites, which is due to racism and social stratification. In this study, we investigated the association between parental education and children’s sleep problems, as a proxy of sleep problems, by race. Methods: This cross-sectional study included 11718 American children aged 9-10. All participants were recruited to the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was parental education, a five-level nominal variable. The dependent variable – sleep problems, was a continuous variable. Race/ethnicity was the effect modifier. Age, sex, and marital status were the covariates. Mixed-effects regression models were used for data analysis. Results: Parental education was associated with children’s sleep problems. However, there was a weaker inverse association seen in non-Latino Black and Latino families compared to non-Latino White families. This was documented by a significant statistical interaction between race and ethnicity and parental education on children’s sleep problems. Conclusion: Diminished protective effect of parental education on children’s sleep problems for non-Latino Black and Latino families compared to non-Latino White families is similar to the MDRs in other domains. Worse than expected sleep may contribute to higher-than-expected health risks of middle-class Black and Latino children.

Parental Education and Left Lateral Orbitofrontal Cortical Activity during N-Back Task: An fMRI Study of American Adolescents

Introduction. The Orbitofrontal Cortex (OFC) is a cortical structure that has implications in cognition, memory, reward anticipation, outcome evaluation, decision making, and learning. As such, OFC activity correlates with these cognitive brain abilities. Despite research suggesting race and socioeconomic status (SES) indicators such as parental education may be associated with OFC activity, limited knowledge exists on multiplicative effects of race and parental education on OFC activity and associated cognitive ability. Purpose. Using functional brain imaging data from the Adolescent Brain Cognitive Development (ABCD) study, we tested the multiplicative effects of race and parental education on left lateral OFC activity during an N-Back task. In our study, we used a sociological rather than biological theory that conceptualizes race and SES as proxies of access to the opportunity structure and exposure to social adversities rather than innate and non-modifiable brain differences. We explored racial variation in the effect of parental educational attainment, a primary indicator of SES, on left lateral OFC activity during an N-Back task between Black and White 9–10 years old adolescents. Methods. The ABCD study is a national, landmark, multi-center brain imaging investigation of American adolescents. The total sample was 4290 9–10 years old Black or White adolescents. The independent variables were SES indicators, namely family income, parental education, and neighborhood income. The primary outcome was the average beta weight for N-Back (2 back versus 0 back contrast) in ASEG ROI left OFC activity, measured by functional Magnetic Resonance Imaging (fMRI) during an N-Back task. Ethnicity, age, sex, subjective SES, and family structure were the study covariates. For data analysis, we used linear regression models. Results. In White but not Black adolescents, parental education was associated with higher left lateral OFC activity during the N-Back task. In the pooled sample, we found a significant interaction between race and parental education on the outcome, suggesting that high parental education is associated with a larger increase in left OFC activity of White than Black adolescents. Conclusions. For American adolescents, race and SES jointly influence left lateral OFC activity correlated with cognition, memory, decision making, and learning. Given the central role of left lateral OFC activity in learning and memory, our finding calls for additional research on contextual factors that reduce the gain of SES for Black adolescents. Cognitive inequalities are not merely due to the additive effects of race and SES but also its multiplicative effects.

Accelerated aging: A marker for social factors resulting in cardiovascular events?

BACKGROUND

Medicine and public health are shifting away from a purely "personal responsibility" model of cardiovascular disease (CVD) prevention towards a societal view targeting social and environmental conditions and how these result in disease. Given the strong association between social conditions and CVD outcomes, we hypothesize that accelerated aging, measuring earlier health decline associated with chronological aging through a combination of biomarkers, may be a marker for the association between social conditions and CVD.

METHODS

We used data from the Coronary Artery Risk Development in Young Adults study (CARDIA). Accelerated aging was defined as the difference between biological and chronological age. Biological age was derived as a combination of 7 biomarkers (total cholesterol, HDL, glucose, BMI, CRP, FEV1/h2, MAP), representing the physiological effect of "wear and tear" usually associated with chronological aging. We studied accelerated aging measured in 2005-06 as a mediator of the association between social factors measured in 2000-01 and 1) any incident CVD event; 2) stroke; and 3) all-cause mortality occurring from 2007 through 18.

RESULTS

Among 2978 middle-aged participants, mean (SD) accelerated aging was 3.6 (11.6) years, i.e., the CARDIA cohort appeared to be, on average, 3 years older than its chronological age. Accelerated aging partially mediated the association between social factors and CVD (N=219), stroke (N=36), and mortality (N=59). Accelerated aging mediated 41% of the total effects of racial discrimination on stroke after adjustment for covariates. Accelerated aging also mediated other relationships but to lesser degrees.

CONCLUSION

We provide new evidence that accelerated aging based on easily measurable biomarkers may be a viable marker to partially explain how social factors can lead to cardiovascular outcomes and death.

Race, Gender, and Socioeconomic Variations in C-Reactive Protein Using the Health and Retirement Study

OBJECTIVES

To clarify the relationships among race, gender, and socioeconomic status (SES) with C-reactive protein (CRP).

METHOD

The present study analyzed data from 6,521 Black and White respondents aged 51 and older in the Health and Retirement Study, a nationally representative sample of midlife and older adults, to address two aims. We sought to (i) assess the independent associations between race, gender, and SES with CRP concentrations and (ii) test whether race, gender, and SES interacted to produce unequal CRP concentrations cross-sectionally and over a 4-year follow-up.

RESULTS

The results demonstrated that race, gender, and SES were each independently associated with baseline CRP, but only SES was associated with CRP at follow-up. Furthermore, race, gender, and education interacted to produce differential CRP levels at baseline. There were incremental benefits for each additional level of education for White men and women, but the relationship between education and CRP was more complicated for Black men and women. Compared with other race/gender groups with less than high school, Black women had the highest and Black men had the lowest levels of CRP. There were no apparent benefits to CRP for Black women with college compared with Black women with high school, while Black men with less than high school and college had similar concentrations of CRP.

DISCUSSION

In clarifying the complexity inherent in CRP disparities, this work contributes to a greater understanding of the biological mechanisms underlying racial disparities in leading causes of morbidity and mortality in the United States.

Everyday Discrimination, Depressive Symptoms, and Suicide Ideation Among African American Men

Suicide has remained a leading cause of death among African American males, yet empirical investigations that focus on the experiences of this group are limited. Therefore, we aim to interrogate the impact of everyday discrimination as a risk factor for depressive symptoms and suicide ideation among African American men. Data were drawn from the African American male subsample of the National Survey of American Life (n = 1,271). Path analysis and tests for indirect effects were used to examine relationships between everyday discrimination, depressive symptoms, and suicide ideation. Three sources of everyday discrimination were examined (any everyday discrimination, race-based everyday discrimination, and other everyday discrimination). Study findings revealed that race-based everyday discrimination was the only type of discrimination that was significantly associated with both increased rates of depressive symptoms and suicide ideation. Further, the indirect effect from race-based everyday discrimination to suicide ideation via depressive symptoms was also statistically significant. Thus, the impact of daily encounters with discrimination extends beyond depressive symptoms and is related to higher rates of suicide ideation. Moreover, experiences with discrimination do not have to be overt to be harmful toward African American men's mental health. Culturally relevant suicide prevention interventions are needed to account for the role of discrimination in the lives of African American men.

Parental Education, Household Income, and Cortical Surface Area among 9-10 Years Old Children: Minorities' Diminished Returns

Introduction: Although the effects of parental education and household income on children's brain development are well established, less is known about possible variation in these effects across diverse racial and ethnic groups. According to the Minorities' Diminished Returns (MDRs) phenomenon, due to structural racism, social stratification, and residential segregation, parental educational attainment and household income show weaker effects for non-White than White children. Purpose: Built on the MDRs framework and conceptualizing race as a social rather than a biological factor, this study explored racial and ethnic variation in the magnitude of the effects of parental education and household income on children's whole-brain cortical surface area. Methods: For this cross-sectional study, we used baseline socioeconomic and structural magnetic resonance imaging (sMRI) data of the Adolescent Brain Cognitive Development (ABCD) study. Our analytical sample was 10,262 American children between ages 9 and 10. The independent variables were parental education and household income. The primary outcome was the children's whole-brain cortical surface area. Age, sex, and family marital status were covariates. Race and ethnicity were the moderators. We used mixed-effects regression models for data analysis as participants were nested within families and study sites. Results: High parental education and household income were associated with larger children's whole-brain cortical surface area. The effects of high parental education and high household income on children's whole-brain cortical surface area were modified by race. Compared to White children, Black children showed a diminished return of high parental education on the whole-brain cortical surface area when compared to White children. Asian American children showed weaker effects of household income on the whole-brain cortical surface area when compared to White children. We could not find differential associations between parental education and household income with the whole-brain cortical surface area, when compared to White children, for non-Hispanic and Hispanic children. Conclusions: The effects of parental educational attainment and household income on children's whole-brain cortical surface area are weaker in non-White than White families. Although parental education and income contribute to children's brain development, these effects are unequal across racial groups.

Parental Education, Household Income, Race, and Children's Working Memory: Complexity of the Effects

Background. Considerable research has linked social determinants of health (SDoHs) such as race, parental education, and household income to school performance, and these effects may be in part due to working memory. However, a growing literature shows that these effects may be complex: while the effects of parental education may be diminished for Blacks than Whites, household income may explain such effects. Purpose. Considering race as sociological rather than a biological construct (race as a proxy of racism) and built on Minorities' Diminished Returns (MDRs), this study explored complexities of the effects of SDoHs on children's working memory. Methods. We borrowed data from the Adolescent Brain Cognitive Development (ABCD) study. The total sample was 10,418, 9- and 10-year-old children. The independent variables were race, parental education, and household income. The primary outcome was working memory measured by the NIH Toolbox Card Sorting Test. Age, sex, ethnicity, and parental marital status were the covariates. To analyze the data, we used mixed-effect regression models. Results. High parental education and household income were associated with higher and Black race was associated with lower working memory. The association between high parental education but not household income was less pronounced for Black than White children. This differential effect of parental education on working memory was explained by household income. Conclusions. For American children, parental education generates unequal working memory, depending on race. This means parental education loses some of its expected effects for Black families. It also suggests that while White children with highly educated parents have the highest working memory, Black children report lower working memory, regardless of their parental education. This inequality is mainly because of differential income in highly educated White and Black families. This finding has significant public policy and economic implications and suggests we need to do far more than equalizing education to eliminate racial inequalities in children's cognitive outcomes. While there is a need for multilevel policies that reduce the effect of racism and social stratification for middle-class Black families, equalizing income may have more returns than equalizing education.

Comparison of European, African, Asian, and Other/Mixed Race American Children for the Association Between Household Income and Perceived Discrimination

Introduction

Perceived discrimination is one of the reasons behind racial/ethnic health disparities. However, less is known about racial and ethnic groups differ in social determinants of discrimination. This study aimed to compare the association between household income and perceived discrimination among American children of different racial/ethnic groups.

Methods

The Adolescent Brain Cognitive Development (ABCD) study, a national longitudinal study, followed 4383 children 9-10 years old who were either European American, African American, Asian American, or mixed/other race for one year. We compared racial and ethnic groups for the association between baseline household income and perceived discrimination at the end of one year follow up. We used ANOVA and linear regression for data analysis. The outcome was perceived discrimination. The predictor was household income. Covariates were age, gender, and parental marital status. The moderator was race/ethnicity.

Results

In the total sample, high household income was associated with less perceived discrimination. There was an interaction between race and household income, suggesting a difference in the association between household income and perceived discrimination between African American and European American children. The inverse association between household income and perceived discrimination was weaker for African American than European American children.

Conclusion

High-income African American children are not well protected against perceived discrimination. High exposure to perceived discrimination may explain the worse expected health and development of middle-class African American children. As discrimination is a major social determinant of health, the results have considerable implications for public and health policy.

Mental Rotation in American Children: Diminished Returns of Parental Education in Black Families

Background: While parental education and family socioeconomic status (SES) are associated with an increase in children's cognitive functioning, and less is known about racial variation in these effects. Minorities' Diminished Returns (MDRs) suggest that, under racism and social stratification, family SES and particularly parental education show weaker effects on children's tangible outcomes for marginalized, racialized, and minoritized families, particularly Blacks, compared to Whites. Aim: We conducted this study to compare the effect of parental education on children's mental rotation abilities, as an important aspect of cognitive function, by race. Methods: This cross-sectional study included 11,135 9-10-year-old American children. Data came from baseline of the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was parental education. The dependent variable, mental rotation, was measured by the Little Man Task. Ethnicity, gender, age, marital status, and household income were the covariates. Results: Parental education was positively associated with mental rotation. However, parental education showed a weaker association with mental rotation in Black than in White families. This was documented by a significant interaction between race and parental education on children's efficiency score. Conclusion: Parental education shows a weaker correlation with mental rotation of Black rather than White children, which is probably because of racism, social stratification, and discrimination. This finding is in line with the MDRs phenomenon and suggests that marginalization and racism may interfere with the influences of parental assets and resources and Black American children's development.

Race/ethnic differences in educational gradients in sleep duration and quality among U.S. adults

At the population level, those with more education tend to report better sleep, mirroring the education gradient found in other health outcomes. But research has shown that higher educational attainment does not always confer the same health benefits for Non-Hispanic Black (Black) and Hispanic adults as it does for Non-Hispanic White (White) adults. It is therefore possible that the educational gradient in sleep varies across racial/ethnic groups in the United States. Using the 2004–2018 National Health Interview Survey (N = 356,048), we examined differences in self-reported sleep duration and sleep quality by level of educational attainment and race/ethnicity. Utilizing multinomial (sleep duration) and negative binomial (times in the past week with difficulty falling asleep and staying asleep) regression models, we found that, compared to their less educated counterparts, college or more educated Whites were more likely to report ideal sleep compared to short or long sleep, and also reported fewer times with difficulty falling or staying asleep. The education-sleep association was generally reversed for Black and Hispanic adults, with the worst sleep being reported by those with college-level education. These patterns remained after adjusting for health behaviors, health outcomes, and socioeconomic status. Our study suggests that education does not yield the same protective benefit for sleep among Black and Hispanic adults as it does for White adults, and that highly educated Black and Hispanic adults in particular experience a sleep disadvantage. The differential education gradient in sleep may, therefore, be an important factor underlying current racial and ethnic health disparities.

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Greater education was associated with fewer sleep problems for Whites.

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This association was generally reversed for Blacks and Hispanics.

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Education may be a “double-edged sword” for the sleep of Blacks and Hispanics.

Not Race or Age but Their Interaction Predicts Pre-Adolescents' Inhibitory Control

Background

African American pre-adolescents are at a higher risk of risky behaviors such as aggression, drug use, alcohol use, and subsequent poor outcomes compared to Caucasian pre-adolescents. All these high-risk behaviors are connected to low levels of inhibitory control (IC).

Aim

We used the Adolescent Brain Cognitive Development (ABCD) data to compare Caucasian and African American pre-adolescents for the effect of age on pre-adolescents IC, a driver of high-risk behaviors.

Methods

This cross-sectional analysis included 4,626 pre-adolescents between ages 9 and 10 from the ABCD study. Regression was used to analyze the data. The predictor variable was age measured in months. The main outcome was IC measured by a stop-signal task (SST). Race was the effect modifier.

Results

Overall, age was associated with IC. Race also showed a statistically significant interaction with age on pre-adolescents' IC, indicating weaker effects of age on IC for African American than Caucasian pre-adolescents.

Conclusion

Age-related changes in IC are more pronounced for Caucasian than African American pre-adolescents. To eliminate the racial gap in brain development between African American and Caucasian pre-adolescents, we should address structural and societal barriers that alter age-related development for racial minority pre-adolescents. Social and public policies, rather than health policies, are needed to address structural and societal barriers that hinder African American adolescents' brain development. Interventions should add resources to the urban areas that many African American families live in so their children can have better age-related brain development. Such changes would be essential given IC in pre-adolescents is a predictor of a wide range of behaviors.

American Children's Screen Time: Diminished Returns of Household Income in Black Families

While increased household income is associated with overall decreased screen time for children, less is known about the effect of racial variation on this association. According to Minorities' Diminished Returns (MDRs) theory, family income and other economic resources show weaker association with children's developmental, behavioral, and health outcomes for racialized groups such as black families, due to the effect of racism and social stratification. In this study, we investigated the association, by race, between family income and children's screen time, as a proxy of screen time. This longitudinal study followed 15,022 American children aged 9-11 over a 1-year period. The data came from the baseline of the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was family income, and it was categorized as a three-level nominal variable. The dependent variable, screen time, was a continuous variable. Ethnicity, gender, parental education, and marital status were the covariates. The results showed that family income was inversely associated with children's screen time. However, there was a weaker inverse association seen in black families when compared with white families. This was documented by a significant statistical interaction between race and family income on children's screen time. Diminished association between family income and children's screen time for black families, compared with white families, is similar to MDRs and reflects a health risk to high-income black children. In a society where race and skin color determine opportunities and treatment by society, children from middle class black families remain at risk across multiple domains. We should not assume that income similarly promotes the health of all racial and ethnic groups. Addressing health and behavioral inequalities requires interventions that go beyond equalizing socioeconomic resources for black families. Marginalization, racism, and poverty interfere with the normal family income-related development of American children.