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Francis B, Pearl M, Colen C, Shoben A, Sealy-Jefferson S. Racial and Economic Segregation Over the Life Course and Incident Hypertensive Disorders of Pregnancy Among Black Women in California. Am J Epidemiol 2024; 193:277-284. [PMID: 37771041 PMCID: PMC11031219 DOI: 10.1093/aje/kwad192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023] Open
Abstract
Black women in the United States have the highest incidence of hypertensive disorders of pregnancy (HDP) and are disproportionately burdened by its adverse sequalae, compared with women of all racial and ethnic groups. Segregation, a key driver of structural racism for Black families, can provide information critical to understanding these disparities. We examined the association between racial and economic segregation at 2 points and incident HDP using intergenerationally linked birth records of 45,204 Black California-born primiparous mothers (born 1982-1997) and their infants (born 1997-2011), with HDP ascertained from hospital discharge records. Women's early childhood and adulthood neighborhoods were categorized as deprived, mixed, or privileged based on the Index of Concentration at the Extremes (a measure of concentrated racial and economic segregation), yielding 9 life-course trajectories. Women living in deprived neighborhoods at both time points experienced the highest odds of HDP (from mixed effect logistic regression, unadjusted odds ratio = 1.26, 95% confidence interval: 1.13, 1.40) compared with women living in privileged neighborhoods at both time points. All trajectories involving residence in a deprived neighborhood in early childhood or adulthood were associated with increased odds of HDP, whereas mixed-privileged and privileged-mixed trajectories were not. Future studies should assess the causal nature of these associations.
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Affiliation(s)
- Brittney Francis
- Correspondence to Dr. Brittney Francis, 651 Huntington Avenue, Floor 7, Boston, MA 02115 (e-mail: )
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Nash KA, Weerahandi H, Yu H, Venkatesh AK, Holaday LW, Herrin J, Lin Z, Horwitz LI, Ross JS, Bernheim SM. Measuring Equity in Readmission as a Distinct Assessment of Hospital Performance. JAMA 2024; 331:111-123. [PMID: 38193960 PMCID: PMC10777266 DOI: 10.1001/jama.2023.24874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024]
Abstract
Importance Equity is an essential domain of health care quality. The Centers for Medicare & Medicaid Services (CMS) developed 2 Disparity Methods that together assess equity in clinical outcomes. Objectives To define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value). Design, Setting, and Participants Cross-sectional study of US hospitals eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019. Main Outcomes and Measures We created a definition of equitable readmissions using CMS Disparity Methods, which evaluate hospitals on 2 methods: outcomes for populations at risk for disparities (across-hospital method); and disparities in care within hospitals' patient populations (within-a-single-hospital method). Exposures Hospital patient demographics; hospital characteristics; and 3 measures of hospital performance-quality, cost, and value (quality relative to cost). Results Of 4638 hospitals, 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% [IQR, 0.2%-8.8%] vs 3.3% [IQR, 0.7%-10.8%], P < .01; race, 7.6% [IQR, 3.2%-16.6%] vs 9.3% [IQR, 4.0%-19.0%], P = .01), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size; P < .01). In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions (odds ratio, 1.57 [95% CI, 1.38-1.77), and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions (odds ratio, 1.14 [95% CI, 1.03-1.26]), and there was no relationship between cost and value, and equity. Conclusion and Relevance A minority of hospitals achieved equitable readmissions. Notably, hospitals with equitable readmissions were characteristically different from those without. For example, hospitals with equitable readmissions served fewer Black patients, reinforcing the role of structural racism in hospital-level inequities. Implementation of an equitable readmission measure must consider unequal distribution of at-risk patients among hospitals.
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Affiliation(s)
- Katherine A. Nash
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Himali Weerahandi
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco
| | - Huihui Yu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Arjun K. Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Louisa W. Holaday
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeph Herrin
- Flying Buttress Associates, Charlottesville, Virginia
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Zhenqiu Lin
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Leora I. Horwitz
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
| | - Joseph S. Ross
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Division of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Deputy Editor, JAMA
| | - Susannah M. Bernheim
- Division of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Now with Centers for Medicaid and Medicare Services, Baltimore, Maryland
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Cundiff JM, Bennett A, Williams A, Cushman M, Howard VJ. Association between psychosocial factors and C-reactive protein across income, race, and sex. Health Psychol 2024; 43:7-18. [PMID: 37428772 PMCID: PMC10776820 DOI: 10.1037/hea0001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE A health disparity is a health difference that adversely affects disadvantaged populations, and thus could plausibly be due to social factors. Biopsychosocial processes that contribute to health disparities are not well-understood. Establishing whether candidate biomarkers are similarly associated with biologically relevant psychosocial constructs across health disparity groups is a current gap in our understanding. METHOD This study examined associations between perceived stress, depressive symptoms, and social support with C-reactive protein (CRP) and whether associations varied by race, sex, or income in 24,395 Black and White adults aged 45 years or older from the REGARDS population-based national cohort. RESULTS The association between depressive symptoms and CRP was slightly larger at higher (vs. lower) income levels and larger for men (vs. women) but did not vary by race. Associations between stress and CRP and social support and CRP were not moderated by income, race, or sex. An interaction between race and income, evidenced that higher income was more strongly associated with lower CRP in White participants compared to Black participants, consistent with the idea of "diminishing returns" of income for the health of Black Americans. CONCLUSIONS Basic associations between these psychosocial factors and CRP are small and generally similar across income, race, and sex. Black and lower-income Americans likely evidence higher CRP due to greater exposure to psychosocial risk factors rather than increased biological vulnerability to these exposures. Additionally, given small associations, CRP should not be used as a proxy for the construct of psychosocial stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Sun S. Racial/Ethnic Heterogeneity in Parental Wealth and Substance Use from Adolescence to Young Adulthood. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01893-y. [PMID: 38114858 DOI: 10.1007/s40615-023-01893-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Substance use has a negative impact on health outcomes, at the individual and population levels. Little consensus exists regarding the relationship between socioeconomic position and substance use across race/ethnicity. This study examines how race/ethnicity and socioeconomic factors, especially parental wealth, are associated with substance use across an 18-year span from adolescence to young adulthood. METHOD Data were drawn from the National Longitudinal Survey of Youth 1997. Substance use behaviors were measured by self-reported heavy episodic drinking, daily cigarette smoking, and use of cannabis. Parental wealth and parental education were measured at baseline. Other socioeconomic factors included education, employment status, and household income. Two-level logistic regression was performed. RESULTS White respondents were more likely to drink, smoke cigarettes, and use cannabis compared to other racial/ethnic groups. More parental wealth was associated with greater odds of heavy episodic drinking, but lower odds of cigarette and cannabis usage. Race/ethnicity modifies the relationships between parental wealth and substance use. Whereas Black respondents from wealthier families had lower odds of heavy episodic drinking, the direction was opposite among white respondents. Wealth functioned as a protective factor against smoking for all groups, although to a lesser extent among respondents of color than for white respondents. Finally, wealthier Hispanics were more likely to smoke daily and use cannabis compared to other racial/ethnic groups. CONCLUSION These findings highlight a nuanced patterning of racial/ethnic heterogeneity in the relationship between parental wealth and substance use behaviors. Implications for policy and programming are discussed.
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Affiliation(s)
- Sicong Sun
- School of Social Welfare, The University of Kansas, 1545 Lilac Lane, Lawrence, KS, 66045, USA.
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Boen CE, Yang YC, Aiello AE, Dennis AC, Harris KM, Kwon D, Belsky DW. Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis. Demography 2023; 60:1815-1841. [PMID: 37982570 PMCID: PMC10842850 DOI: 10.1215/00703370-11057546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Despite the prominence of the weathering hypothesis as a mechanism underlying racialized inequities in morbidity and mortality, the life course social and economic determinants of Black-White disparities in biological aging remain inadequately understood. This study uses data from the Health and Retirement Study (n = 6,782), multivariable regression, and Kitagawa-Blinder-Oaxaca decomposition to assess Black-White disparities across three measures of biological aging: PhenoAge, Klemera-Doubal biological age, and homeostatic dysregulation. It also examines the contributions of racial differences in life course socioeconomic and stress exposures and vulnerability to those exposures to Black-White disparities in biological aging. Across the outcomes, Black individuals exhibited accelerated biological aging relative to White individuals. Decomposition analyses showed that racial differences in life course socioeconomic exposures accounted for roughly 27% to 55% of the racial disparities across the biological aging measures, and racial disparities in psychosocial stress exposure explained 7% to 11%. We found less evidence that heterogeneity in the associations between social exposures and biological aging by race contributed substantially to Black-White disparities in biological aging. Our findings offer new evidence of the role of life course social exposures in generating disparities in biological aging, with implications for understanding age patterns of morbidity and mortality risks.
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Affiliation(s)
- Courtney E Boen
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Claire Yang
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison E Aiello
- Robert N. Butler Columbia Aging Center, Columbia University, New York, NY, USA
| | - Alexis C Dennis
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Kathleen Mullan Harris
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dayoon Kwon
- Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Daniel W Belsky
- Columbia Mailman School of Public Health and Robert N. Butler Columbia Aging Center, Columbia University, New York, NY, USA
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Pantesco EJ, Kan IP. Racial and ethnic disparities in self-reported sleep duration: Roles of subjective socioeconomic status and sleep norms. Sleep Med 2023; 112:246-255. [PMID: 37925851 DOI: 10.1016/j.sleep.2023.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES There are racial and ethnic disparities in sleep duration, with members of historically marginalized groups typically reporting shorter sleep than White Americans. This study examines subjective social status (SSS) as a moderator, and variation in ideal sleep norms as a mediator, of differences in sleep duration between racial/ethnic groups. METHODS Asian, Black, Hispanic, and non-Hispanic White respondents in an online survey reported their typical weeknight and weekend-night sleep duration, along with estimates of ideal sleep duration norms. Objective and subjective indicators of socioeconomic status were also assessed. A conditional process analysis was used to examine whether racial or ethnic differences in sleep duration were a) moderated by SSS and b) mediated by ideal sleep duration norms. RESULTS Racial/ethnic disparities in sleep duration varied by group. Hispanic participants reported shorter weeknight sleep than White participants. In Asian and Black participants, shorter weeknight sleep relative to White participants was only observed at medium (Black) or high (Black and Asian) levels of SSS. Shorter norms for ideal sleep duration partially mediated differences in sleep duration between Black and White adults, but not the other racial/ethnic groups. There was no evidence of moderated mediation. Neither income nor education moderated racial/ethnic disparities in sleep duration. CONCLUSIONS Racial and ethnic disparities in sleep duration may partially depend on SSS. Continued research into moderators and mediators of racial/ethnic differences in sleep duration is warranted.
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Affiliation(s)
- Elizabeth J Pantesco
- Department of Psychological and Brain Sciences, Villanova University, Villanova, PA, United States.
| | - Irene P Kan
- Department of Psychological and Brain Sciences, Villanova University, Villanova, PA, United States.
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Hawkins M, Mallapareddi A, Misra D. Social mobility and perinatal depression in Black women. FRONTIERS IN HEALTH SERVICES 2023; 3:1227874. [PMID: 37693235 PMCID: PMC10491480 DOI: 10.3389/frhs.2023.1227874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023]
Abstract
Background Higher socioeconomic position is associated with better birth outcomes and maternal mental health, although this relationship is less consistent for Black women. The literature is limited on the impact of social mobility across the life course on mental health of pregnant women. This study examines the impact of perceived financial status across the life-course on depressive symptoms during pregnancy among Black women. Methods Data were from the Life-course Influences of Fetal Environments (LIFE) retrospective cohort study among pregnant Black women in metropolitan Detroit, Michigan. Depressive symptoms in the two weeks prior to birth were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Social mobility was determined at three intervals over the life course using self-report of financial status during childhood, adolescence, and current age in pregnancy. Results 1,410 pregnant women participated, ranging in age from 18 to 45 years old. CES-D scores ranged from 0 to 53 (mean = 15.3) and 26% of the sample reported high depressive symptoms. In each age interval, higher financial status was associated with significant protective effect on depressive symptoms, and the magnitude of the effect increased across the life course. Trajectory analysis demonstrated that both the upward (4.51; 95% CI, 2.43-6.6) and downward (4.04; 95% CI, 2.62-5.46 and 3.09; 95% CI, 1.57-4.62) life-course social mobility groups had increased mean CES-D scores compared to the static social mobility group. Conclusion This study describes the importance of previous childhood and current financial status effects on mental health in Black pregnant women.
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Affiliation(s)
- Melissa Hawkins
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
| | - Arun Mallapareddi
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Dawn Misra
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
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Brown TH, Hargrove TW, Homan P, Adkins DE. Racialized Health Inequities: Quantifying Socioeconomic and Stress Pathways Using Moderated Mediation. Demography 2023; 60:675-705. [PMID: 37218993 PMCID: PMC10841571 DOI: 10.1215/00703370-10740718] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Racism drives population health inequities by shaping the unequal distribution of key social determinants of health, such as socioeconomic resources and exposure to stressors. Research on interrelationships among race, socioeconomic resources, stressors, and health has proceeded along two lines that have largely remained separate: one examining differential effects of socioeconomic resources and stressors on health across racialized groups (moderation processes), and the other examining the role of socioeconomic resources and stressors in contributing to racial inequities in health (mediation processes). We conceptually and analytically integrate these areas using race theory and a novel moderated mediation approach to path analysis to formally quantify the extent to which an array of socioeconomic resources and stressors-collectively and individually-mediate racialized health inequities among a sample of older adults from the Health and Retirement Study. Our results yield theoretical contributions by showing how the socioeconomic status-health gradient and stress processes are racialized (24% of associations examined varied by race), substantive contributions by quantifying the extent of moderated mediation of racial inequities (approximately 70%) and the relative importance of various social factors, and methodological contributions by showing how commonly used simple mediation approaches that ignore racialized moderation processes overestimate-by between 5% and 30%-the collective roles of socioeconomic status and stressors in accounting for racial inequities in health.
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Affiliation(s)
- Tyson H. Brown
- Department of Sociology and Population Research Institute, Duke University, Durham, NC, USA
| | - Taylor W. Hargrove
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patricia Homan
- Department of Sociology, Center for Demography and Population Health, and Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee, FL, USA
| | - Daniel E. Adkins
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
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Patel OP, Quist A, Martin CL, Wegienka G, Baird DD, Wise LA, Vines AI. Life-Course Mobility in Socioeconomic Position and High Depressive Symptoms Among Young Black Women: The SELF Study. Womens Health Issues 2023; 33:266-272. [PMID: 36588050 PMCID: PMC10213084 DOI: 10.1016/j.whi.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current literature on the association between mobility in socioeconomic position (SEP) and depression demonstrates mixed findings, with variation in the benefits of upward SEP by racial group and ethnic background. No study has examined life-course SEP mobility and depressive symptoms among Black women in the United States. METHODS Our cohort included 1,612 Black women enrolled in the Study of Environment, Lifestyle and Fibroids between 2010 and 2012 and followed for 5 years. We used data on socioeconomic indicators at childhood and adulthood and used latent class analysis to create a life-course SEP mobility measure (persistently low, downward, upward, and persistently high). Using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D), we assessed high (≥9) versus low depressive symptoms. Multivariable log risk models were used to produce risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS Of the participants, 37% had high depressive symptoms. Persistently low (RR, 1.56; 95% CI, 1.31-1.86) and downward (RR, 1.36; 95% CI, 1.14-1.63) SEP mobility was associated with high depressive symptoms after adjustment for age, adult social support, and marital status. There was evidence of an effect measure modification by adult social support, with a stronger association among those who reported high adult social support compared with low adult social support. CONCLUSIONS These findings suggest directing mental health resources to people experiencing low SEP at any stage in life, especially those with low SEP in adulthood, to aid in the management of depressive symptoms.
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Affiliation(s)
- Opal P Patel
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Arbor Quist
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Chantel L Martin
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Anissa I Vines
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina.
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Hudson D, Collins-Anderson A, Hutson W. Understanding the Impact of Contemporary Racism on the Mental Health of Middle Class Black Americans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1660. [PMID: 36767028 PMCID: PMC9914282 DOI: 10.3390/ijerph20031660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 06/18/2023]
Abstract
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.
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Bijou C, Colen CG. Shades of health: Skin color, ethnicity, and mental health among Black Americans. Soc Sci Med 2022; 313:115387. [PMID: 36223699 PMCID: PMC10731906 DOI: 10.1016/j.socscimed.2022.115387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/17/2022] [Accepted: 09/19/2022] [Indexed: 01/26/2023]
Abstract
Skin color is an important predictor of health outcomes among Black Americans. Black Americans with darker complexions experience worse physical and psychological functioning than those with lighter complexions. However, most research on the health effects of colorism focuses solely on African Americans, omitting the experiences of other Black subpopulations. Using data from the National Survey of American Life (NSAL), we investigate the relationship between skin color and mental health among African Americans (N = 3393) and Caribbean Blacks (N = 1378). Findings from multivariate logistic regressions reveal that Black Americans with the lightest complexions-regardless of ethnicity-report worse psychological functioning. However, the shape of the association between skin tone and mental health varies significantly based on ethnicity and the specific psychiatric outcome under study. For Caribbean Blacks, the association between skin color and any mental disorders and mood disorders is linear, while the relationship for anxiety disorders is curvilinear. For African Americans, the relationship between skin color and mental health shows an elevated risk among only those with the lightest skin tones. These results illustrate the heterogeneity within the Black community and highlight the importance of recognizing ethnicity in health disparities research.
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Affiliation(s)
- Christina Bijou
- Department of Sociology, The Ohio State University, USA; Institute for Population Research, The Ohio State University, USA.
| | - Cynthia G Colen
- Department of Sociology, The Ohio State University, USA; Institute for Population Research, The Ohio State University, USA.
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DeAngelis RT. "Moving on Up? Neighborhood Status and Racism-Related Distress among Black Americans". SOCIAL FORCES; A SCIENTIFIC MEDIUM OF SOCIAL STUDY AND INTERPRETATION 2022; 100:1503-1532. [PMID: 35847476 PMCID: PMC9285664 DOI: 10.1093/sf/soab075] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
At all levels of socioeconomic status, Black Americans can expect to live shorter and sicker lives than their White counterparts. This study advances the perspective that anti-Black stigma from Whites precludes Blacks from reaping the full health rewards of higher status, particularly within the context of neighborhoods. To test this hypothesis, I merge census data with rich survey and biomarker data from the Nashville Stress and Health Study, a representative sample of Black and White adults from Davidson County, Tennessee (n = 1,252). Initially, I find that Blacks who reside in higher-status and mostly White communities exhibit lower levels of neuroendocrine stress hormones, relative to their peers living in disadvantaged Black neighborhoods. But Blacks in higher-status areas also report more perceived discrimination. In turn, perceived discrimination is associated with chronic bodily pain, as well as elevated stress hormones and blood pressure tied to high goal-striving stress, or fears of being blocked from reaching life goals. After accounting for racism-related stressors, Blacks exhibit comparable levels of physiological distress regardless of neighborhood context. The inverse is true for Whites, who report fewer stressors in higher-status neighborhoods, and less physiological distress than Blacks overall. Findings are discussed within the context of social evolutionary theories of the human brain and are dovetailed with broader racial health disparities in the United States.
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Affiliation(s)
- Reed T. DeAngelis
- Department of Sociology and the Carolina Population Center, University of North Carolina at Chapel Hill
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13
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Cundiff JM, Bennett A, Carson AP, Judd SE, Howard VJ. Socioeconomic status and psychological stress: Examining intersection with race, sex and US geographic region in the REasons for Geographic and Racial Differences in Stroke study. Stress Health 2022; 38:340-349. [PMID: 34461676 DOI: 10.1002/smi.3095] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022]
Abstract
Socioeconomic status (SES) is a well-established determinant of health. Disparities in stress are thought to partially account for SES-health disparities. We tested whether multiple indicators of SES show similar associations with psychological stress and whether race, sex, and geographic region moderate associations. Participants (n = 26,451) are from a well-characterized national cohort of Black and White US adults aged 45 years or older. Psychological stress was measured using the 4-item perceived stress scale. Income was assessed as annual household income and education as highest level of education completed. Occupation was assessed during a structured interview and subsequently coded hierarchically. For all sex-race-region groups, the largest SES-stress associations were for income and the smallest were for occupation. Race moderated SES-stress associations, such that income and education were more closely associated with stress in Black adults than White adults. Additionally, education was more strongly associated with stress in individuals living in the stroke belt region. Black Americans with lower income and education reported greater psychological stress and may be at higher risk for disease through stress-related pathways. Thus, which SES indicator is examined and for whom may alter the magnitude of the association between SES and psychological stress.
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Affiliation(s)
| | - Aleena Bennett
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April P Carson
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne E Judd
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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Homan P, Brown TH, King B. Structural Intersectionality as a New Direction for Health Disparities Research. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:350-370. [PMID: 34355603 PMCID: PMC8628816 DOI: 10.1177/00221465211032947] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This article advances the field by integrating insights from intersectionality perspectives with the emerging literatures on structural racism and structural sexism-which point to promising new ways to measure systems of inequality at a macro level-to introduce a structural intersectionality approach to population health. We demonstrate an application of structural intersectionality using administrative data representing macrolevel structural racism, structural sexism, and income inequality in U.S. states linked to individual data from the Behavioral Risk Factor Surveillance System to estimate multilevel models (N = 420,644 individuals nested in 76 state-years) investigating how intersecting dimensions of structural oppression shape health. Analyses show that these structural inequalities: (1) vary considerably across U.S. states, (2) intersect in numerous ways but do not strongly or positively covary, (3) individually and jointly shape health, and (4) are most consistently associated with poor health for black women. We conclude by outlining an agenda for future research on structural intersectionality and health.
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Clouston SAP, Link BG. A retrospective on fundamental cause theory: State of the literature, and goals for the future. ANNUAL REVIEW OF SOCIOLOGY 2021; 47:131-156. [PMID: 34949900 PMCID: PMC8691558 DOI: 10.1146/annurev-soc-090320-094912] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Fundamental Cause Theory (FCT) was originally proposed to explain how socioeconomic inequalities in health emerged and persisted over time. The concept was that higher socioeconomic status helped some people to avoid risks and adopt protective strategies using flexible resources - knowledge, money, power, prestige and beneficial social connections. As a sociological theory, FCT addressed this issue by calling on social stratification, stigma, and racism as they affected medical treatments and health outcomes. The last comprehensive review was completed a decade ago. Since then, FCT has been tested, and new applications have extended central features. The current review consolidates key foci in the literature in order to guide future research in the field. Notable themes emerged around types of resources and their usage, approaches used to test the theory, and novel extensions. We conclude that after 25 years of use, there remain crucial questions to be addressed.
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Affiliation(s)
- Sean A. P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Bruce G. Link
- School of Public Policy and Department of Sociology, University of California at Riverside, Riverside, CA, USA
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Beatty Moody DL, Waldstein SR, Leibel DK, Hoggard LS, Gee GC, Ashe JJ, Brondolo E, Al-Najjar E, Evans MK, Zonderman AB. Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research. PLoS One 2021; 16:e0251174. [PMID: 34010303 PMCID: PMC8133471 DOI: 10.1371/journal.pone.0251174] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/21/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives To examine whether intersections of race with other key sociodemographic categories contribute to variations in multiple dimensions of race- and non-race-related, interpersonal-level discrimination and burden in urban-dwelling African Americans and Whites. Methods Data from 2,958 participants aged 30–64 in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to estimate up to four-way interactions of race, age, gender, and poverty status with reports of racial and everyday discrimination, discrimination across multiple social statuses, and related lifetime discrimination burden in multiple regression models. Results We observed that: 1) African Americans experienced all forms of discrimination more frequently than Whites, but this finding was qualified by interactions of race with age, gender, and/or poverty status; 2) older African Americans, particularly African American men, and African American men living in poverty reported the greatest lifetime discrimination burden; 3) older African Americans reported greater racial discrimination and greater frequency of multiple social status-based discrimination than younger African Americans; 4) African American men reported greater racial and everyday discrimination and a greater frequency of social status discrimination than African American women; and, 5) White women reported greater frequency of discrimination than White men. All p’s < .05. Conclusions Within African Americans, older, male individuals with lower SES experienced greater racial, lifetime, and multiple social status-based discrimination, but this pattern was not observed in Whites. Among Whites, women reported greater frequency of discrimination across multiple social statuses and other factors (i.e., gender, income, appearance, and health status) than men. Efforts to reduce discrimination-related health disparities should concurrently assess dimensions of interpersonal-level discrimination across multiple sociodemographic categories, while simultaneously considering the broader socioecological context shaping these factors.
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Affiliation(s)
- Danielle L. Beatty Moody
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
- * E-mail:
| | - Shari R. Waldstein
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland, United States of America
| | - Daniel K. Leibel
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
| | - Lori S. Hoggard
- Department of Psychology, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Gilbert C. Gee
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Jason J. Ashe
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
| | - Elizabeth Brondolo
- Department of Psychology, St. John’s University, Queens, New York, New York, United States of America
| | - Elias Al-Najjar
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, Maryland, United States of America
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
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McClain AC, Gallo LC, Mattei J. Subjective Social Status and Cardiometabolic Risk Markers by Intersectionality of Race/Ethnicity and Sex Among U.S. Young Adults. Ann Behav Med 2021; 56:442-460. [PMID: 33942845 DOI: 10.1093/abm/kaab025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Subjective social status (SSS) has shown inverse relationships with cardiometabolic risk, but intersectionalities of race/ethnicity and sex may indicate more nuanced relationships. PURPOSE To investigate associations of SSS with cardiometabolic risk markers by race/ethnicity and sex. METHODS Data were from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (n = 4,847; 24-32 years), which collected biological cardiometabolic risk markers. A 10-step ladder captured SSS; respondents indicated on which step they perceived they stood in relation to other people in the U.S. higher values indicated higher SSS (range: 1-10). We tested the relationship between SSS and individual markers using generalized least square means linear regression models, testing three-way interactions between SSS, race/ethnicity, and sex (p < .10) before stratification. RESULTS SSS-race/ethnicity-sex interactions were significantly associated with waist circumference (p ≤ .0001), body mass index (BMI; p ≤ .0001), systolic blood pressure (SBP; p ≤ .0001), diastolic blood pressure (DBP; p = .0004), and high-density lipoprotein cholesterol (HDL-C; p = .07). SSS was associated with waist circumference (β [SE]: -1.2 (0.4), p < .05) and BMI (-0.6 [0.2], p < .01) for non-Hispanic White females, compared with males; with HDL-C among non-Hispanic White (0.2 [0.1]; p < .05) and Hispanic (0.3 (0.1); p < .05) females, compared with males; with SBP for non-Hispanic Asian (1.7 [0.8]; p < .05) and Multiracial (1.8 [0.8]; p < .05), versus White, females; and with DBP for non-Hispanic Black (0.8 [0.3]; p < .01), versus White, males. CONCLUSIONS SSS was differentially related to cardiometabolic risk markers by race/ethnicity and sex, suggesting intersectional aspects. Clinical and research applications of SSS should consider race/ethnicity- and sex-specific pathways influencing cardiometabolic risk.
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Affiliation(s)
- Amanda C McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Josiemer Mattei
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Hudson D, Sacks T, Irani K, Asher A. The Price of the Ticket: Health Costs of Upward Mobility among African Americans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1179. [PMID: 32069785 PMCID: PMC7068450 DOI: 10.3390/ijerph17041179] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/16/2020] [Accepted: 02/03/2020] [Indexed: 01/09/2023]
Abstract
There is a growing literature that has documented diminishing health returns on upward social mobility among Black Americans. Due to historical policies and practices, upward social mobility is often an arduous, isolating process for Black Americans, especially as they navigate predominately white educational and workplace settings. This paper advances the literature in several meaningful and innovative ways. The goal of this paper is to provide a qualitative account of the health costs of upward social mobility and describe how these costs could diminish health returns despite greater levels of socioeconomic resources. Focus groups and surveys were the data collection methods for the study. Inclusion criteria for the study were that respondents identified as African American or Black, were 24 years or older and had completed college. The total sample was 32 college-educated Black men (n = 12) and women (n = 20). The mean age for men was 39 (range = 26-50) and 33 years of age (range = 24-59) for women. Key findings highlighted in this paper include (1) hypervisibility and subsequent vigilance; (2) uplift stress; and (3) health costs associated with social mobility. The sum of these stressors is posited to affect multiple health outcomes and elucidate the mechanisms through which socioeconomic returns on health are diminished.
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Affiliation(s)
- Darrell Hudson
- Brown School of Social Work, Washington University, St. Louis, MO 63130, USA;
| | - Tina Sacks
- School of Social Welfare, University of California at Berkeley, Berkeley, CA 94720, USA;
| | - Katie Irani
- Brown School of Social Work, Washington University, St. Louis, MO 63130, USA;
| | - Antonia Asher
- School of Public Health, Tulane University, New Orleans, LA 70112, USA;
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Whitley JC, Peralta CA, Haan M, Aiello AE, Lee A, Ward J, Zeki Al Hazzouri A, Neuhaus J, Moyce S, López L. The association of parental and offspring educational attainment with systolic blood pressure, fasting blood glucose and waist circumference in Latino adults. Obes Sci Pract 2018; 4:582-590. [PMID: 30574351 PMCID: PMC6298209 DOI: 10.1002/osp4.307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/14/2018] [Accepted: 09/22/2018] [Indexed: 12/29/2022] Open
Abstract
Objective The objective of the study is to evaluate the association of intergenerational educational attainment with cardiovascular disease (CVD) risk factors among US Latinos. Methods We used cross‐sectional data from the Niños Lifestyle and Diabetes Study, an offspring cohort of middle‐aged Mexican‐Americans whose parents participated in the Sacramento Latino Study on Aging. We collected educational attainment, demographic and health behaviours and measured systolic blood pressure (SBP), fasting glucose and waist circumference. We evaluated the association of parental, offspring and a combined parent–offspring education variable with each CVD risk factor using multivariable regression. Results Higher parental education was associated only with smaller offspring waist circumference. In contrast, higher offspring education was associated with lower SBP, fasting glucose and smaller waist circumference. Adjustment for parental health behaviours modestly attenuated these offspring associations, whereas adjustment for offspring health behaviours and income attenuated the associations of offspring education with offspring SBP and fasting glucose but not smaller waist circumference, even among offspring with low parental education. Conclusions Higher offspring education is associated with lower levels of CVD risk factors in adulthood, despite intergenerational exposure to low parental education.
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Affiliation(s)
- J C Whitley
- University of California, San Francisco San Francisco CA USA
| | - C A Peralta
- University of California, San Francisco San Francisco CA USA
| | - M Haan
- University of California, San Francisco San Francisco CA USA
| | - A E Aiello
- Gillings School of Public Health University of North Carolina Chapel Hill NC USA
| | - A Lee
- University of California, San Francisco San Francisco CA USA
| | - J Ward
- Gillings School of Public Health University of North Carolina Chapel Hill NC USA
| | | | - J Neuhaus
- University of California, San Francisco San Francisco CA USA
| | - S Moyce
- College of Nursing Montana State University MT USA
| | - L López
- University of California, San Francisco San Francisco CA USA
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