Black Deaths Matter: Race, Relationship Loss, and Effects on Survivors

Death of a Parent, Racial Inequities, and Cardiovascular Disease Risk in Early to Mid-adulthood

Black Americans experience the death of a parent much earlier in the life course than White Americans on average. However, studies have not considered whether the cardiovascular health consequences of early parental death vary by race. Using data from the National Longitudinal Study of Adolescent to Adult Health, we explore associations between early parental death and cardiovascular disease (CVD) risk in early to mid-adulthood (N = 4,193). We find that the death of a parent during childhood or adolescence (ages 0-17) or the transition to adulthood (ages 18-27) is associated with increased CVD risk for Black Americans, whereas parental death following the transition to adulthood (ages 28+) undermines cardiovascular health for both Black Americans and White Americans. These findings illustrate how a stress and life course perspective can help inform strategies aimed at addressing both the unequal burden of bereavement and high cardiovascular risk faced by Black Americans.

Life course and mental health: a thematic and systematic review

Objective

This study explored the influence of the life course on mental health by identifying key trends, seminal works, and themes in existing research. Additionally, it highlights the major discussions at the intersection of life course and mental health.

Methods

Documents were extracted from the Web of Science Core Collection (WoSCC), to systematically analyze themes on mental health outcomes across the life course. The analysis was based on key bibliometric tools, including VOSviewer 1.6.11, R Studio software, and GraphPad Prism 9 to analyze the evolution and impact of scholarly contributions in this domain.

Results

The accumulated body of research concerning the life course's impact on mental health, which began to emerge around 1990 displayed a consistently upward trend. Predominant contributions originate from developed nations and frequently look into the psychosocial determinants of mental health over life course. Life course and mental health studies have been extensively infused with biopsychosocial frameworks that consider the role of genetic makeup, neurodevelopment, cognition, affect, sociocultural dynamics, and interpersonal relationships. Life course theory application in mental health highlight the substantive effects of accumulated adversities, notably social determinants of health, adverse childhood experiences (ACEs), and their implications for subsequent mental health outcomes.

Conclusion

The nexus of life course and mental health outcomes demands further scholarly interrogation, particularly within underserved regions, to strengthen protective mechanisms for vulnerable populations.

Empty chairs at the dinner table: Black-white disparities in exposure to household member deaths

As a result of Black-White inequities in life expectancy, recent research has indicated that Black individuals are disproportionately exposed to the deaths of multiple family members compared to White individuals. Black individuals are also more likely to live in coresident households-that is, households that extend beyond the nuclear family. However, it is unclear the degree to which this population may be disproportionately exposed to the loss of deaths marked by the geographic closeness of the household. In this study, I use data from the Panel Study of Income Dynamics to provide the first nationally representative estimates of Black-White disparities in exposure to household member deaths. I find that Black people are significantly more likely than White individuals to have experienced the death of a household member. Based on these findings, I argue the dual inequities of racial disparities in life expectancy and racial disparities in coresidence are an overlooked, salient source of racial disparities in exposure to death. By illuminating a broader range of network sources that contribute to racial inequities in exposure to death, this study sets forth a new conceptual unit of analysis-that of the household-to investigate the intergenerational reproduction of inequality in health and socioeconomic status due to exposure to death.

Racial/Ethnic Differences in Loneliness Among Older Adults: The Role of Income and Education as Mediators

Background and Objectives

Loneliness is a major public health concern; however, limited research has examined the mechanisms contributing to racial/ethnic inequities in loneliness. Race/ethnicity has been hypothesized to be a distal factor influencing loneliness, and racial/ethnic inequities in loneliness may be attributable to socioeconomic factors (e.g., income and education). Our study seeks to confirm these hypotheses by examining mechanisms that contribute to racial/ethnic inequities in loneliness. In other words, if racial/ethnic differences in loneliness among older adults are mediated by income and education.

Research Design and Methods

Data came from the Health and Retirement Study Leave-Behind Questionnaire, 2014-2016. Loneliness was measured by the UCLA 3-item loneliness scale. Race/ethnicity categories were White, Black, and Hispanic/Latino. The mediator variables were household income and education. Multivariable linear regression models were used to determine differences in loneliness by race/ethnicity. The Karlson-Holm-Breen (KHB) mediation method was used to determine if income and education mediated racial/ethnic differences in loneliness.

Results

In models examining income and education together, a complete mediation was found between White and Black older adults, in that income and education completely mediated differences in loneliness between these groups. A partial mediation was found between White and Hispanic, and Black and Hispanic older adults. When examining income and education separately, we found that income solely accounted for racial/ethnic differences in loneliness compared to education.

Discussion and Implications

Our study is the first to explicitly determine if socioeconomic factors mediate race/ethnicity differences in loneliness among a national sample of older adults. These findings illustrate that income may have greater proximate effects for loneliness among older adults in comparison to education. Additionally, these findings can inform evidence-based interventions to reduce loneliness among older adults. Interventions that enhance quality of life and provide opportunities for socialization for racialized low-income older adults may help decrease racial/ethnic inequities in loneliness.

COVID-19 Booster Uptake: Are Hesitant Adopters Less Likely to Get a Booster Shot Than Nonhesitant Adopters?

The main objective of this study was to assess whether hesitancy toward receiving the initial COVID-19 vaccine was associated with uptake of the COVID-19 booster several months after it became available to all US adults. We ask whether hesitancy toward the initial COVID-19 vaccine was significantly associated with lower odds of COVID-19 booster uptake among adults. We test this association within the context of the highly rural state of Arkansas. By January 2022, the US had set a global record of nearly 1 million daily cases. The purpose of this study was to advance our understanding of vaccine hesitancy among those who have already received a dose of the COVID-19 vaccine and how that hesitancy may shape COVID-19 booster uptake. We analyzed data from a random sample survey of Arkansan adults (N = 2,201) between March 1 and March 28, 2022 and constrained our analytical sample to those who had received a vaccine (N = 1,649). Nearly two-thirds of vaccinated Arkansas residents had received a COVID-19 booster. Hesitancy was common even among vaccinated individuals and was significantly associated with reduced odds of COVID-19 booster uptake, even after controlling for other factors. Findings provide further support for conceptualizing vaccine hesitancy as an attitude related to-but separate from-the behavior of vaccination, as opposed to conflating vaccination with being nonhesitant. Public health interventions aimed at increasing COVID-19 booster uptake should pay attention to vaccine hesitancy indicated at the initiation of the series and should not ignore the vaccinated as an important population to target for intervention.

Working Through It: Lifetime Experiences of Employment Discrimination Among Older Black Americans and Implications for Labor Force Participation, Job Dissatisfaction, and Mental Health in Older Adulthood

OBJECTIVES

To examine lifetime experiences of employment discrimination and their association with Black older adults' employment status and well-being.

METHODS

We use data from the Health and Retirement Study's leave-behind questionnaire to characterize lifetime experiences of being unfairly fired, not hired, or not promoted among Black older adults (N = 2948) and test associations with labor force status at age 62, job satisfaction among those working, and depressive symptoms.

RESULTS

Employment discrimination was commonly reported by Black older adults, especially among men and those with college educations. Employment discrimination was not associated with employment status at age 62 but was associated with job dissatisfaction (OR = 2.00, p = .001) and depressive symptoms (Beta = 0.34, p < .001).

DISCUSSION

Findings suggest a negative association between employment discrimination at any point in the life course and Black older adults' well-being. Employment discrimination is an obstacle to healthy aging, yet improved discrimination survey items are needed to fully capture its impact on Black Americans.

Youth Experiencing Parental Death Due to Drug Poisoning and Firearm Violence in the US, 1999-2020

Importance

Youth (those aged <18 years) parental death has been associated with negative health outcomes. Understanding the burden of parental death due to drug poisoning (herein, drugs) and firearms is essential for informing interventions.

Objective

To estimate the incidence of youth parental death due to drugs, firearms, and all other causes.

Design, Setting, and Participants

This cross-sectional observational study was conducted using vital registration, including all US decedents, and census data from January 1990 through December 2020. Data were analyzed from May 30, 2023, to March 28, 2024.

Exposures

Parental death due to drug poisoning or firearms.

Main Outcomes and Measures

A demographic matrix projection model was used to estimate the number and incidence of youth experiencing parental death, defined as the death of 1 or more parents, per 1000 population aged less than 18 years. Analyses evaluated parental deaths by drugs, firearms, and all other causes from 1999 through 2020 by race and ethnicity.

Results

Between 1999 and 2020, there were 931 785 drug poisoning deaths and 736 779 firearm-related deaths with a mean (SD) age of 42.6 (16.3) years. Most deaths occurred among males (73.8%) and White decedents (70.8%) followed by Black (17.5%) and Hispanic (9.5%) decedents. An estimated 759 000 (95% CI, 722 000-800 000) youth experienced parental death due to drugs and an estimated 434 000 (95% CI, 409 000-460 000) youth experienced parental death due to firearms, accounting for 17% of all parental deaths. From 1999 to 2020, the estimated number of youth who experienced parental death increased 345% (95% CI, 334%-361%) due to drugs and 39% (95% CI, 37%-41%) due to firearms compared with 24% (95% CI, 23%-25%) due to all other causes. Black youth experienced a disproportionate burden of parental deaths, based primarily on firearm deaths among fathers. In 2020, drugs and firearms accounted for 23% of all parental deaths, double the proportion in 1999 (12%).

Conclusions and Relevance

Results of this modeling study suggest that US youth are at high and increasing risk of experiencing parental death by drugs or firearms. Efforts to stem this problem should prioritize averting drug overdoses and firearm violence, especially among structurally marginalized groups.

Estimating the Sex Gap in Depression-Free Life Expectancy Among Widowed Americans Aged 50 and Older: An Application Using the Interpolated Markov Chain Approach

OBJECTIVES

Using Interpolated Markov Chain software, we compare the length of life with and without depression among married individuals and widowers, and the related sex differences.

METHODS

We applied a multi-state life table approach to estimate depression-free life expectancy among recent cohorts of older married and widowed women and men in the United States, using data from the Health and Retirement Study over a 7-year period (2012-2018).

RESULTS

The study revealed that the difference in life expectancy between sexes widens in the context of widowhood. At age 50, the sex gap in depression-free life expectancy is 0.8 years among married people, whereas the gap almost doubles to 1.7 years among widowed people.

DISCUSSION

By quantifying disparities in the duration of life affected by depression between married and widowed women and men, policymakers could properly allocate resources specifically to address the mental health needs of these groups.

Depression among incarcerated persons following the death of a loved one: Does social support mitigate grief?

The death of a loved one generates adverse and potentially damaging consequences for surviving family members and friends. The challenges of bereavement can be especially severe when experienced by incarcerated persons who must cope with and grieve the death while incarcerated. Yet, limited research evaluates bereavement among incarcerated persons and whether factors such as social support buffer against health-related consequences. Using data from the LoneStar Project-a study of 802 incarcerated men in Texas-we examine depressive symptoms among currently incarcerated persons with differential exposure to a loved one's death (i.e., immediate family, friends, extended family). Importantly, a high rate of death exists among incarcerated persons' loved ones, with 41% in the sample losing someone on the outside during their final year of incarceration. However, we find that external social support from family and friends and in-prison social cohesion from peers, significantly mitigate the harms of bereavement on depressive symptoms.

Social Isolation and Population Density: Racial and Ethnic Differences Among Older Adults

This study uses secondary data analysis to assess the relationship between social isolation (SI) and population density in the US, as well as any moderating influence that race/ethnicity may have on that relationship. A recent consensus on the measure of SI is that it focuses on the objective absence of social connections, whereas loneliness refers to subjective assessments of one's social connections. Therefore, while the original study measured both objective and subjective SI may be innovative, it may also be overly ambitious. SI puts older people at risk for health problems, including an increased chance of dying. The AARP Foundation gathered the initial convenience sample, which included 8149 senior citizens. The study determined population density using self-reported zip codes, measured as persons per square mile, and divided the results into tertiles. Linear mixed models were used to investigate the moderating role of race/ethnicity between population density and SI. The findings revealed that greater population density was associated with less SI for individuals residing in zip codes with a higher percentage of the same race/ethnicity, but more SI for those in zip codes with a lower percentage of the same race/ethnicity. These results suggest that race/ethnicity should be considered in future studies or when developing policies and interventions to address SI among older adults in high-population-density areas. For example, when policymakers aim to address SI in a community, they may want to collect data based on zip codes and create targeted interventions for specific racial/ethnic groups within those zip code areas.

Parental Death Across the Life Course, Social Isolation, and Health in Later Life: Racial/Ethnic Disadvantage in the U.S

Bereavement is a risk factor for poor health, yet prior research has not considered how exposure to parental death across the life course may contribute to lasting social isolation and, in turn, poor health among older adults. Moreover, prior research often fails to consider the racial context of bereavement in the United States wherein Black and Hispanic Americans are much more likely than White Americans to experience parental death earlier in life. The present study uses longitudinal data from the Health and Retirement Study (HRS; 1998-2016) to consider linkages of parental death, social isolation, and health (self-rated health, functional limitations) for Black, Hispanic, and White older adults. Findings suggest that exposure to parental death is associated with higher levels of isolation, greater odds of fair/poor self-rated health, and greater odds of functional limitations in later life. Moreover, social isolation partially explains associations between parental bereavement and later-life health. These patterns persist net of psychological distress-an additional psychosocial response to bereavement. Racial inequities in bereavement are central to disadvantage: Black and Hispanic adults are more likely to experience a parent's death earlier in the life course, and this differential exposure to parental death in childhood or young adulthood has implications for racial and ethnic inequities in social isolation and health throughout life.

Lost support, lost skills: Children's cognitive outcomes following grandparental death

OBJECTIVE

This study examines the implications of grandparental death for cognitive skills in middle childhood.

METHOD

This study uses data from the Future of Families and Child Wellbeing Study (N = 2479) to estimate ordinary least squares regression models of the associations between grandparental death and subsequent cognitive skills among children in middle childhood.

RESULTS

Experiencing a grandparental death between ages 5 and 9 is associated with boys' lower reading, verbal, and math scores at age 9, with associations most notable for Black and Hispanic boys; grandparental death before age 5 has minimal influence on boys' cognitive skills at age 9. There is little indication that grandparental death adversely affects girls' cognitive skills.

CONCLUSION

The numerous and persistent implications of grandparental death for boys' cognitive skills merit greater recognition of grandparental death as a source of family instability, stress, and ultimately inequality in child development.

A progressive agenda toward equity in pain care

Background: There are inconsistencies documenting the pain experience of Black adults and other racially minoritized populations. Often disregarded, pain among these groups is characterized by misconceptions, biases, and discriminatory practices, which may lead to inequitable pain care. Methods: To address this issue, this professional commentary provides an overview of pain reform and the need to declare chronic pain as a critical public health issue, while requiring that equity be a key focus in providing comprehensive pain screening and standardizing epidemiological surveillance to understand the prevalence and incidence of pain. Results and Conclusions: This roadmap is a call to action for all sectors of research, practice, policy, education, and advocacy. More importantly, this progressive agenda is timely for all race and other marginalized groups and reminds us that adequate treatment of pain is an obligation that cannot be the responsibility of one person, community, or institution, but rather a collective responsibility of those willing to service the needs of all individuals.

Race-Ethnic Differences in the Effects of COVID-19 on the Work, Stress, and Financial Outcomes of Older Adults

OBJECTIVES

This study investigates race-ethnic differences among older non-Hispanic Black, non-Hispanic White, and Hispanic adults' financial, employment, and stress consequences of COVID-19.

METHODS

We use data from the Health and Retirement Study, including the 2020 COVID-panel, to evaluate a sample of 2,929 adults using a combination of bivariate tests, OLS regression analysis, and moderation tests.

RESULTS

Hispanic and non-Hispanic Black older adults experienced more financial hardships, higher levels of COVID-19 stress, and higher rates of job loss associated with COVID-19 relative to their Non-Hispanic White counterparts. Non-Hispanic Black and Hispanic adults reported significantly higher levels of COVID-19 resilience resources, yet, these resources were not protective of the consequences of COVID-19.

DISCUSSION

Understanding how the experiences of managing and coping with COVID-19 stressors differ by race-ethnicity can better inform intervention design and support services.

Family deaths in the early life course and their association with later educational attainment in a longitudinal cohort study

Due to structural racism and pathways between racism and health, Black and Native American people die at younger ages than white people. This means that those groups are likely to experience deaths of family members at younger ages. Evidence is mixed about whether family deaths affect educational attainment. We aim to 1) estimate the prevalence of family deaths by age and race 2) estimate the effect of a family death on later educational attainment and 3) analyze whether the effect of a family death varies by age, socioeconomic status, gender, and race. The National Longitudinal Study of Adolescent to Adult Health (Add Health) is a nationally representative sample of U.S. adolescents in grades 7-12 at baseline in 1994-1995. Add Health has a large and racially diverse sample and records family deaths across the entire life course starting from birth. Participants were included in this analysis if they reported their educational attainment in Wave IV (N = 14,796). The racial group with the lowest proportion experiencing a sibling or parent death in the first 23 years of their lives was white participants (11.7%), followed by Asian (12.5%), Hispanic (15.0%), Black (24.3%) and Native American participants (30.3%). In adjusted models, those who experienced a family death had 0.60 times the odds (95% CI 0.51-0.71) of achieving a bachelor's degree compared to those without a family death. Mother deaths, father deaths, and sibling deaths were each harmful for obtaining a college degree and their effects were similar in magnitude. The age range when the effect of a family death was strongest was 10-13 years old (OR = 0.52 95% CI 0.40-0.67). The effect of a family death on college degree attainment did not vary by baseline parent education, participant sex, or race/ethnicity.

Sleep quality moderates the association between family bereavement and heart rate variability

Two separate bodies of literature point to the link between family bereavement and cardiovascular health and between sleep quality and cardiovascular outcomes. However, less is known about the joint influence of family bereavement and sleep quality on cardiovascular functioning. The aims of this study were to examine the relationships between experiencing the death of a family member and heart rate variability (HRV) and to further explore whether these associations differ by sleep quality. Using data from the Midlife in the United States (MIDUS) Biomarker Project, the sample for this study included respondents who experienced the death of an immediate family member - father, mother, spouse, sibling, or child - within a year before the Biomarker project and those who did not experience any deaths (N = 962). We used two measures of HRV and sleep quality was measured using the Pittsburgh Sleep Quality Index. Results showed that experiencing the death of a family member was associated with worse HRV only among those with poor sleep quality and not for those with good sleep quality. These results suggest that poor sleep quality may indicate psychophysiological vulnerability for those who experienced the death of a family member. Interventions to improve sleep quality could be effective in enhancing cardiovascular health of bereaved individuals.

Social Isolation: An Unequally Distributed Health Hazard

Social isolation is a potent predictor of poor health, mortality, and dementia risk. A great deal of research across national contexts provides causal evidence for these linkages and identifies key explanatory mechanisms through which isolation affects health. Research on social isolation recognizes that some people are more likely than others to be isolated, but over the past several decades, researchers have focused primarily on the consequences of isolation for health rather than a systematic assessment of the social conditions that foster isolation over the life course. In this article, we review the available evidence on inequities in social isolation and develop a conceptual framework to guide future research on structural systems that fuel social isolation over the life course. Future work in this area has the potential to identify root causes of inequality in social isolation, as well as targeted policy levers to reduce isolation in vulnerable populations.

Mental health among bereaved youth in the ALSPAC birth cohort: Consideration of early sociodemographic precursors, cognitive ability, and type of loss

BACKGROUND

Bereaved youth are at greater risk for adverse mental health outcomes, yet less is known about how social context shapes health for bereaved children. Ecosocial theory is employed to conceptualize bereavement in the context of sociodemographic factors.

METHOD

This longitudinal study used data from the Avon Longitudinal Study of Parents and Children. Of the 15,454 pregnancies enrolled, 5050 youth were still enrolled at age 16.5 and completed self-report questionnaires on life events and emotional/behavioral symptoms.

RESULTS

Sociodemographic precursors associated with parent, sibling, or close friend bereavement included maternal smoking, parental education levels, and financial difficulties. The significant yet small main effect of higher cognitive ability, assessed at age 8, on reduced emotional/behavioral symptoms at age 16.5 (β = -0.01, SE = 0.00, p < 0.001) did not interact with bereavement. Bereavement of a parent, sibling, or close friend was associated with a 0.19 point higher emotional/behavioral symptom log score compared to non-bereaved youth (95% CI: 0.10-0.28), across emotional, conduct, and hyperactivity subscales.

CONCLUSIONS

Descriptive findings suggest sociodemographic precursors are associated with bereavement. While there was an association between the bereavement of a parent, sibling, or close friend and elevated emotional/behavioral symptoms, cognitive ability did not moderate that effect.

COVID-19 Vaccine Hesitancy and Experiences of Discrimination Among Black Adults

Early in the COVID-19 vaccine rollout, Black adults consistently reported more hesitancy than White adults, but few studies have examined variation in hesitancy among Black adults or its associations with racial discrimination. Data were collected from Black Arkansas residents age 18 and older (n = 350) between July 12th and July 30th, 2021, as part of a larger survey of Arkansans (N = 1500). Participants were recruited through random digit dialing of both landline and cell phones, with oversampling of Black and Hispanic residents. Respondents reported COVID-19 vaccine hesitancy, sociodemographic information, influenza vaccination history, pandemic-related experiences, and experiences of racial discrimination. Almost half (48.9%) of Black adults in Arkansas were not hesitant towards COVID-19 vaccines, while the remainder reported some level of hesitancy. Nearly a quarter were very hesitant (22.4%), while fewer reported being somewhat (14.0%) and a little (14.7%) hesitant. Using an ordered logistic regression with partial proportional odds, we find odds of COVID-19 vaccine hesitancy decreased as age and influenza vaccination increased. Odds of COVID-19 vaccine hesitancy were 1.70 times greater for Black adults who experienced the death of a close friend/family member due to COVID-19 and 2.61 times greater for individuals reporting discrimination with police or in the courts. Within-group analysis revealed nearly half of Black adults did not report any COVID-19 vaccine hesitancy and heterogeneity among those who were hesitant. Findings suggest there may be an important link between racial discrimination in the criminal justice system and COVID-19 vaccine hesitancy among Black adults.

Exposure to negative life events, change in their perceived impact, and subsequent well-being among U.S. adults: A longitudinal outcome-wide analysis

OBJECTIVE

Negative life events have the potential to undermine an individual's ability to function and thrive, but less is known about the implications of changes in subjective appraisals of those events for long-term well-being. This research examines how exposure to negative life events and subsequent changes in the perceived impact of those events are related to longer-term well-being in adulthood.

METHOD

Drawing on three waves of data from the Midlife in the United States study (M1: 1995-1996, M2: 2004-2006, M3: 2013-2014), we applied the analytic template for outcome-wide longitudinal designs to investigate associations of (a) negative life event exposure between M1 and M2 and (b) change in the perceived impact of negative life event exposure assessed at M2 with 25 outcomes across several domains of well-being assessed approximately 9 years later at M3: psychological distress, psychological well-being, social well-being, prosociality, physical health, and health behavior.

RESULTS

Whereas negative life event exposure was associated with worse subsequent well-being on selected outcomes (5/25 in total) in some domains, positive change in the perceived impact of negative life event exposure was associated with better well-being on one or more outcomes in most domains (11/25 in total). Effect sizes in both sets of analyses were generally small, with more consistent associations found for psychological and social outcomes.

CONCLUSION

Subjective appraisals of negative life events (particularly positive changes in those appraisals over time) may be more closely related to individual well-being in the long run than mere exposure to negative life events themselves. The findings bring attention to the possibility that positive changes in a person's subjective appraisal of negative life events could have beneficial consequences for long-term well-being.

Neighborhood Opportunity and Mortality Among Children and Adults in Their Households

BACKGROUND AND OBJECTIVES

Research has linked neighborhood opportunity to health outcomes in children and adults; however, few studies have examined neighborhood opportunity and mortality risk among children and their caregivers. The objective of this study was to assess associations of neighborhood opportunity and mortality risk in children and their caregivers over 11 years.

METHODS

Participants included 1 025 000 children drawn from the Mortality Disparities in American Communities study, a cohort developed by linking the 2008 American Community Survey to the National Death Index and followed for 11 years. Neighborhood opportunity was measured using the Child Opportunity Index, a measure designed to capture compounding inequities in access to opportunities for health.

RESULTS

Using hazard models, we observed inverse associations between Child Opportunity Index quintile and deaths among child and caregivers. Children in very low opportunity neighborhoods at baseline had 1.30 times the risk of dying over follow-up relative to those in very high opportunity neighborhoods (95% confidence interval [CI], 1.15-1.45), and this excess risk attenuated after adjustment for household characteristics (hazard ratio, 1.15; 95% CI, 0.98-1.34). Similarly, children in very low opportunity neighborhoods had 1.57 times the risk of experiencing the death of a caregiver relative to those in very high opportunity neighborhoods (95% CI, 1.50-1.64), which remained after adjustment (hazard ratio, 1.30; 95% CI, 1.23-1.38).

CONCLUSIONS

Our analyses advance understanding of the adverse consequences of inequitable neighborhood contexts for child well-being and underscore the potential importance of place-based policies for reducing disparities in child and caregiver mortality.

The cumulative effect of gun homicide-related loss on neighborhood perceptions among street-identified black women and girls: A mixed-methods study

Racial disparities in death indicate that Black women and girls are disproportionately bereaved by violent loss across their lifetime. Yet the context and consequences of this loss remain largely understudied. This study examines the effect of gun homicide-related loss of relative/friends on subjective neighborhood perceptions among street-identified Black women and girls (ages 16 to 54). The study used a convergent mixed-methods design, with simultaneous quantitative and qualitative components. Data were collected from two low-income, high-crime neighborhoods in Wilmington, Delaware. Quantitative data (n = 277) included a community-based survey on health, opportunity and violence. Qualitative data (n = 50) included semi-structured interviews primarily from a sub-group of the survey population. This study used a street participatory action research (Street PAR) methodology, which included members of the target population onto the research project. OLS regression analyses predicted the effect of exposure to gun homicide on perceptions of neighborhood social environment (i.e., safety, aesthetic quality, walkability, social cohesion, and availability of healthy foods). Interviews were analyzed using grounded theory. Approximately 87% of those surveyed were exposed to a relative/friend gun homicide. All interviewees were exposed to a relative/friend gun homicide. Exposure to the gun homicide of either a relative or friend alone was nonsignificant. But the combination of exposure to gun homicides of both a relative and friend was significantly related to poorer neighborhood perceptions, even when controlling for co-occurring factors. Mixed-method findings indicate that the cumulative impact of gun homicide-related loss matters most in shaping negative neighborhood perceptions. Qualitative data suggest that losing multiple members of one's familial and peer networks to homicide is a powerful form of co-victimization that alters how participants conceptualize and navigate public space. Interventions to decrease gun violence should consider how traumatic loss has unintended consequences on the quality of life of co-victims and those in close proximity to street life.

When Death Hits You in Your Face, You Have to Listen": A Qualitative Investigation of Peer Bereavement Support Volunteers in Black American Communities

Efforts to support grief in Black American communities are often under-recognized despite their potential to address negative mental health outcomes in this population. The aim of the current study was to qualitatively assess the community-level influence of bereavement support programs on predominantly Black communities in Baltimore, Maryland. Five focus groups (n = 23) were conducted with volunteers from a non-profit bereavement organization. Participants were queried about how their training may be sustainably applied as a community resource in Baltimore City. Thematic analysis from focus groups revealed three main themes: (1) enhancing feelings of belongingness fosters a sense of community cohesion, (2) use of bereavement support tools as a source of personal healing, and (3) applications of bereavement support in the community. Implications of our study support the widespread influence of peer-led bereavement support training to reduce the reverberating impact of personal and collective grief in Black American communities.

Who Gets Help? A National Longitudinal Study of Personal Networks and Pandemic Support Among Older Adults

OBJECTIVES

Personal networks provide social support for older adults, perhaps especially during the coronavirus disease 2019 (COVID-19) pandemic when traditional avenues may be disrupted. We provide one of the first population-based studies on how prepandemic personal networks predict support during the pandemic among older adults, with attention to gender and race variation.

METHOD

We analyzed longitudinal data from the National Social Life, Health, and Aging Project Round 3 (2015/2016) and COVID-19 Round (2020; N = 2622, 55.68% female, 78.75% White, aged 50-99), a nationally representative survey of community-dwelling older Americans. We considered structure (i.e., size, density) and composition (i.e., proportion female and kin) of prepandemic personal networks, estimating multinomial logistic models to predict self-reported need and receipt of instrumental help and emotional support during the pandemic.

RESULTS

Larger prepandemic confidant networks predicted higher risk of receiving needed pandemic help and support, higher risk of receiving help and support more often than prepandemic, and lower risk of being unable to get help. Denser prepandemic networks also predicted higher risk of receiving pandemic help and support. Furthermore, how network size and density related to support differed with respondent race and a greater proportion of kin in prepandemic networks predicted higher risk of receiving help for non-White older adults only.

DISCUSSION

Older adults' prepandemic confidant network structure and composition can provide underlying conditions for receiving pandemic social support. Findings speak to policies and programs that aim to foster social support or identify vulnerable groups that suffer the greatest unmet need for support during a global crisis.

Flames of transformation: Igniting better mental and physical health for racialized and gendered North Americans

COVID-19 is catalyzing both crises and opportunities for communities of color. The crisis of high mental and physical morbidities and mortalities exposes persistent inequities while providing opportunities to celebrate the power of rejuvenated anti-racism movements, fueled partly in response to the extremism of ultra-conservative governments, the circumstances to reflect deeply on racism because of forced stay-at-home-orders, and digital technologies primarily driven by youth. In marking this historical moment of longstanding anti-racism and decolonial struggles, I assert the importance of foregrounding women's needs. In analyzing racism, rooted in colonialism and white supremacy, and its impacts on mental and physical health status, I focus on improving racialized women's lives within the larger context, concentrating on the determinants of health. I contend that fanning the flames to scathe the racist and sexist foundations of North American society will break new ground for sharing wealth, bolstering solidarity and sisterhood, and ultimately improving Black, Indigenous, and Women of Color (BIWOC) health. Canadian BIWOC earn approximately 59 cents to the dollar earned by non-racialized men, creating vulnerabilities to economic downturns, such as the one Canada is currently in. BIWOC care aides, at the bottom of the healthcare hierarchy, are emblematic of other Black, Indigenous, and People of Color (BIPOC), who face risks of frontline work, low wages, poor job security, unpaid sick days and so forth. To that end, policy recommendations include employment equity initiatives that hire groups of racialized women who consciously express solidarity with each other. Cultural shifts within institutions will be key to providing safe environments. Improving food security, internet access and BIWOC-related data collection linked to community-based programming while prioritizing research on BIWOC will go a long way toward improving BIWOC health. Addressing racism and sexism within the healthcare system, aiming for equitable diagnostic and treatment foci, will require transformative efforts including determined leadership and buy-in from all levels of staff, long-term training and evaluation programs, audited by BIPOC communities.

Racism exposure and trauma accumulation perpetuate pain inequities-advocating for change (RESTORATIVE): A conceptual model

Experiences of racism occur across a continuum from denial of services to more subtle forms of discrimination and exact a significant toll. These multilevel systems of oppression accumulate as chronic stressors that cause psychological injury conceptualized as racism-based traumatic stress (RBTS). RBTS has overlapping symptoms with posttraumatic stress disorder (PTSD) with the added burden that threats are constantly present. Chronic pain is a public health crisis that is exacerbated by the intersection of racism and health inequities. However, the relationship between RBTS and pain has not yet been explored. To highlight how these phenomena are interlinked, we present Racism ExpoSure and Trauma AccumulatiOn PeRpetuate PAin InequiTIes-AdVocating for ChangE (RESTORATIVE); a novel conceptual model that integrates the models of racism and pain and demonstrates how the shared contribution of trauma symptoms (e.g., RBTS and PTSD) maintains and perpetuates chronic pain for racialized groups in the United States. Visualizing racism and pain as "two halves of the same coin," in which the accumulative effects of numerous events may moderate the severity of RBTS and pain, we emphasize the importance of within-group distinctiveness and intersectionality (overlapping identities). We call on psychologists to lead efforts in applying the RESTORATIVE model, acting as facilitators and advocates for the patient's lived experience with RBTS in clinical pain care teams. To assist with this goal, we offer suggestions for provider and researcher antiracism education, assessment of RBTS in pain populations, and discuss how cultural humility is a central component in implementing the RESTORATIVE model. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Multiple Family Member Deaths and Cardiometabolic Health among Black and White Older Adults

Although the bereavement literature is voluminous, we know very little about how exposure to multiple family member deaths across the life course shapes health trajectories as people age and whether unequal exposure to bereavement contributes to racial inequities in cardiometabolic health. We use longitudinal data from the Health and Retirement Study (1992-2016) to consider how multiple family member deaths before midlife shape trajectories of cardiometabolic health after age 50 for Black and white adults (n = 22,974). Results show that multiple family member deaths prior to age 50 are associated with more cardiometabolic conditions at age 50 and a faster increase in conditions with advancing age. Moreover, Black adults are significantly disadvantaged by a greater risk of bereavement and more cardiometabolic conditions regardless of bereavement status. The life course trauma of exposure to multiple family member deaths uniquely contributes to the cardiometabolic risk of Black Americans.

Stress and Mental Health: A Focus on COVID-19 and Racial Trauma Stress

In the United States, COVID-19 unfolded alongside profound racial trauma. Drawing on a population representative sample of 20-60 year-olds who were married or cohabiting, the National Couples' Health and Time Study (N =3,642), we examine two specific sources of stress: COVID-19 and racial trauma. We leverage the fully powered samples of respondents with racial/ethnic and sexual minority identities and find that COVID-19 and racial trauma stress were higher among individuals who were not White or heterosexual most likely due to racism, xenophobia, and cis-heterosexism at the individual and structural levels. Both COVID-19 and racial trauma stress were associated with poorer mental health outcomes even after accounting for a rich set of potential mechanistic indicators, including discrimination and social climate. We argue that the inclusion of assessments of stress are critical for understanding health and well-being among individuals impacted by systemic and interpersonal discrimination.

"Outside the Skin": The Persistence of Black-White Disparities in U.S. Early-Life Mortality

Research on Black-White disparities in mortality emphasizes the cumulative pathways through which racism gets "under the skin" to affect health. Yet this framing is less applicable in early life, when death is primarily attributable to external causes rather than cumulative, biological processes. We use mortality data from the National Vital Statistics System Multiple Cause of Death files and population counts from the Surveillance, Epidemiology, and End Result Program to analyze 705,801 deaths among Black and White males and females, ages 15-24. We estimate age-standardized death rates and single-decrement life tables to show how all-cause and cause-specific mortality changed from 1990 to 2016 by race and sex. Despite overall declines in early-life mortality, Black-White disparities remain unchanged across several causes-especially homicide, for which mortality is nearly 20 times as high among Black as among White males. Suicide and drug-related deaths are higher among White youth during this period, yet their impact on life expectancy at birth is less than half that of homicide among Black youth. Critically, early-life disparities are driven by preventable causes of death whose impact occurs "outside the skin," reflecting racial differences in social exposures and experiences that prove harmful for both Black and White adolescents and young adults.

Social Determinants Associated With Exposure to Childhood Parental Bereavement and Subsequent Risk for Psychiatric Disorders

IMPORTANCE

Prevalence of childhood parental death varies by race and ethnicity and socioeconomic status, yet whether similar variation persists in the association with lifetime psychiatric disorder is unknown.

OBJECTIVE

To assess whether race and ethnicity and parental educational attainment are associated with the risk of death of a parent; to determine whether the risk for lifetime psychiatric disorder associated with death of a parent was moderated by race and ethnicity and highest parental educational attainment; and to examine a potential intersection of race and ethnicity with parental educational attainment in the risk of lifetime psychiatric disorder associated with death of a parent.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study used data from the National Comorbidity Study: Adolescent Supplement (NCS-A), 2001 to 2004. Participants included youth aged 13 to 18 years, restricted to Black, Hispanic, and White youth due to power limitations. Data were analyzed from February 26, 2021, to April 21, 2022.

EXPOSURE

Death of a parent during childhood.

MAIN OUTCOMES AND MEASURES

The primary study outcome was any lifetime Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) psychiatric disorder, assess via assessed via structured clinical interviews.

RESULTS

Among 9501 youth (mean [SD] age, 15.2 [1.5] years; 50.9% female), including 511 youth who had experienced parental death and 8990 youth who had not, the cumulative hazard of parental death by age 18 years was approximately doubled for Hispanic (10.1%; 95% CI, 6.9%-14.7%) and Black (14.0%; 95% CI, 10.6%-18.4%) youth compared with White youth (6.0%; 95% CI, 4.7%-7.8%). Similar patterns were noted by parental educational attainment: the cumulative hazard of parental death for youth of parents with less educational attainment was nearly double (10.1%; 95% CI, 8.1%-12.6%) compared with youth of parents with more education (6.6%; 95% CI, 5.2%-8.4%). Death of a parent was positively and significantly associated with risk of any lifetime psychiatric disorder (aOR, 1.34; 95% CI, 1.03-1.75) compared with youth who had not experienced death of a parent. However, this association was not moderated by race and ethnicity (aOR, 1.05; 95% CI, 0.58-1.92) or parental educational attainment (aOR, 1.19; 95%, 0.70-2.04), although power analyses suggest that larger sample sizes are needed.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, Black and Hispanic youth experienced elevated parental death compared with White youth, yet the risk for any lifetime psychiatric disorder after parental death was not significantly moderated by race and ethnicity or parental education. Both individual- and population-level interventions may be needed to address the increased risk of psychiatric disorders, although additional studies with larger sample sizes are needed.

The Return of Race Science and Why It Matters for Family Science

Race science attributes differences in human populations to biology and genetics that reflect a hierarchy of human races with whiteness at its pinnacle. This article examining the history of race science and current family scholarship and practice contends that race science matters for family science. We discuss 1) white supremacy, the development of race science, and the eugenics movement in the U.S.; 2) racism, racialized experiences, and oppression of Black families in the U.S.; 3) the construction of whiteness in family science and re-envisioning theories to make racism's impact visible; 4) racial reckonings for professional organizations; and 5) why race science matters for family science and a call to action. Clarity about the meaning of race can ensure that family science addresses white supremacy and racism embedded in scholarship, training, and practice, and promotes work that supports the well-being of families that are most vulnerable and marginalized.

Gender and Social Isolation across the Life Course

Social isolation has robust adverse effects on health, well-being, dementia risk, and longevity. Although most studies suggest similar effects of isolation on the health of men and women, there has been much less attention to gendered patterns of social isolation over the life course-despite decades of research suggesting gender differences in social ties. We build on theoretical frames of constrained choice and gender-as-relational to argue that gender differences in isolation are apparent but depend on timing in the life course and marital/partnership history. Results indicate that boys/men are more isolated than girls/women through most of the life course, and this gender difference is much greater for the never married and those with disrupted relationship histories. Strikingly, levels of social isolation steadily increase from adolescence through later life for both men and women.

Sibling Deaths, Racial/Ethnic Disadvantage, and Dementia in Later Life

OBJECTIVES

Sibling loss is understudied in the bereavement and health literature. The present study considers whether experiencing the death of siblings in mid-to-late life is associated with subsequent dementia risk and how differential exposure to sibling losses by race/ethnicity may contribute to racial/ethnic disparities in dementia risk.

METHODS

We use discrete-time hazard regression models, a formal mediation test, and a counterfactual simulation to reveal how sibling loss in mid-to-late life affects dementia incidence and whether unequal exposures by race/ethnicity mediate the racial/ethnic disparities in dementia. We analyze data from the Health and Retirement Study (2000-2016). The sample includes 13,589 respondents (10,670 non-Hispanic White, 1,761 non-Hispanic Black, and 1,158 Hispanic adults) aged 65 years and older in 2000 who show no evidence of dementia at baseline.

RESULTS

Discrete-time hazard regression results show that sibling loss in mid-to-late life is associated with up to 54% higher risk for dementia. Sibling loss contributes to Black-White disparities in dementia risk. In addition, a simulation analysis shows that dementia rates would be 14% lower for Black adults if they experienced the lower rates of sibling loss experienced by White adults. This pattern was not observed among Hispanic adults.

DISCUSSION

The death of a sibling in mid-to-late life is a stressor that is associated with increased dementia risk. Black adults are disadvantaged in that they are more likely than Whites to experience the death of siblings, and such losses contribute to the already substantial racial/ethnic disadvantage in dementia.

COVID-19 Death Exposure among Adults in the United States

As of May 17, 2022, more than a million deaths due to COVID-19 have been recorded in the US. For each COVID-19 death, there are an estimated nine bereaved family members and an unknown number of bereaved friends. This study aimed to assess the correlates of self-reported COVID-19 death exposure (i.e., loss of a close friend or family member) among US adults using online survey data (n = 1,869) collected between September 17, 2021 and October 3, 2021. One in four US adults in this national sample reported the loss of a close friend or family member due to COVID-19. The odds of losing a close friend or family member due to COVID-19 death were greater for those age 60 or older, all minoritized racial/ethnic groups except for Asian American respondents, married/coupled respondents, those who had foregone care due to cost in the past year, and those who reported a COVID-19 infection.

Mourning in a Pandemic: The Differential Impact of COVID-19 Widowhood on Mental Health

OBJECTIVES

The death of a spouse is an established predictor of mental health decline that foreshadows worsening physical health and elevated mortality. The millions widowed by COVID-19 worldwide may experience even worse health outcomes than comparable pre-pandemic widows given the particularities of dying, mourning, and grieving during a pandemic defined by protracted social isolation, economic precarity, and general uncertainty. If COVID-19 pandemic bereavement is more strongly associated with mental health challenges than pre-pandemic bereavement, the large new cohort of COVID-19 widow(er)s may be at substantial risk of downstream health problems long after the pandemic abates.

METHODS

We pooled population-based Survey of Health, Ageing and Retirement in Europe data from 27 countries for two distinct periods: (1) pre-pandemic (Wave 8, fielded October 2019-March 2020; N = 46,266) and (2) early pandemic (COVID Supplement, fielded June-August 2020; N = 55,796). The analysis used a difference-in-difference design to assess whether a spouse dying from COVID-19 presents unique mental health risks (self-reported depression, loneliness, and trouble sleeping), compared with pre-pandemic recent spousal deaths.

RESULTS

We find strong associations between recent spousal death and poor mental health before and during the pandemic. However, our difference-in-difference estimates indicate those whose spouses died of COVID-19 have higher risks of self-reported depression and loneliness, but not trouble sleeping, than expected based on pre-pandemic associations.

DISCUSSION

These results highlight that the millions of COVID-19 widow(er)s face extreme mental health risks, eclipsing those experienced by surviving spouses pre-pandemic, furthering concerns about the pandemic's lasting impacts on health.

Stressful life events and social support among pregnant Marshallese women

INTRODUCTION

Women from racial and ethnic minority groups in the United States are disproportionately likely to experience adverse perinatal outcomes such as preterm birth, low birthweight infants, and infant mortality. Previous research has demonstrated that exposure to stressful life events and social support may influence perinatal outcomes. Although studies have documented stressful life events and social support for the general United States population and minority groups, less is known about the experiences of Pacific Islander women in the United States, and no prior studies have documented these experiences in Marshallese Pacific Islander women.

METHODS

The present study examined data collected from pregnant Marshallese women (n = 67) in northwest Arkansas participating in a women's health program using descriptive analyses (means, standard deviations, proportions).

RESULTS

Results indicated a high prevalence of three stressful life events: experiencing a family member going into the hospital (35.8%), someone close to them dying (29.9%), and being unable to pay bills (53.7%). Food insecurity was higher than previously reported for pregnant women or Pacific Islanders (83.7%). Social support was high among the sample. A majority of women reported receiving help with daily chores (86.6%), help when sick (88.1%), and support on how to deal with personal problems (85.1%).

DISCUSSION

This study is the first to document the prevalence of stressful life events and social support in a sample of pregnant Marshallese women living in the United States. The findings provide important information to guide efforts to reduce adverse perinatal outcomes in a Pacific Islander population.

Grief Symptoms Promote Inflammation During Acute Stress Among Bereaved Spouses

The death of a spouse is associated with maladaptive immune alterations; grief severity may exacerbate this link. We investigated whether high grief symptoms were associated with an amplified inflammatory response to subsequent stress among 111 recently bereaved older adults. Participants completed a standardized psychological stressor and underwent a blood draw before, 45 min after, and 2 hr after the stressor. Those experiencing high grief symptoms (i.e., scoring > 25 on the Inventory of Complicated Grief) experienced a 45% increase in interleukin-6 (IL-6; a proinflammatory cytokine) per hour, whereas those experiencing low grief symptoms demonstrated a 26% increase. In other words, high grief was related to a 19% increase in IL-6 per hour relative to low grief. The grief levels of recently bereaved people were associated with the rate of change in IL-6 following a subsequent stressor, above and beyond depressive symptoms. This is the first study to demonstrate that high grief symptoms promote inflammation following acute stress.

Sole Family Survivors: Older Adults Lacking Family of Origin Kin

OBJECTIVES

We introduced a unique form of kinlessness: sole family survivorship, which describes the lack of family of origin (i.e., biological parents and siblings) kin. This form of kinlessness may be particularly consequential for older adults who experience other forms of kinlessness (e.g., no spouse/partner or no children) as they are especially likely to have relied on their family of origin for support.

METHODS

Data from the 1998-2014 Health and Retirement Study (N = 148,346 person-waves) were used to estimate the prevalence of sole family survivorship among adults aged 55 and older and men and women aged 55-74 and 75+. Variation in prevalence levels of sole family survivorship across sociodemographic characteristics, health indicators, and family factors were also estimated. Finally, we tracked cohort trends in sole family survivorship.

RESULTS

More than 1 in 10 adults aged 55+ were sole family survivors and this figure rose to more than 1 in 4 among those aged 75+. Adults with no spouse/partner and no children were especially likely to be sole family survivors, meaning they face a double burden of kinlessness.

DISCUSSION

Sole family survivorship represents the culmination of loss of multiple, lifelong kin ties. It is more common among those lacking other close kin, signaling the presence of a uniquely vulnerable group of older adults who experience multiple forms of kinlessness. Future research should address how older adults and society at large adapt to kinlessness to ensure successful aging.

Fictive Kin Networks among African Americans, Black Caribbeans, and Non-Latino Whites

Using data from the National Survey of American Life, we investigated the social and demographic correlates of fictive kin network involvement among African Americans, Black Caribbeans, and non-Latino Whites. Specifically, we examined the factors shaping whether respondents have fictive kin, the number of fictive present kin in their networks, and the frequency with which they received support from fictive kin. Eighty-seven percent of respondents had a fictive kin relationship, the average network size was 7.5, and 61% of participants routinely received fictive kin support. Affective closeness and contact with family, friends, and church members were positively associated with fictive kin relations. Age, region, income and marital and parental status were related to fictive kin network involvement, though these associations varied by race/ethnicity. Collectively, findings indicate that fictive kin ties extend beyond marginalized communities, and they operate as a means to strengthen family bonds, rather than substitute for family deficits.

Expanding the Conceptualization of Support in Low-Wage Carework: The Case of Home Care Aides and Client Death

Home care aides are a rapidly growing, non-standard workforce who face numerous health risks and stressors on the job. While research shows that aides receive limited support from their agency employers, few studies have explored the wider range of support that aides use when navigating work stress and considered the implications of these arrangements. To investigate this question, we conducted 47 in-depth interviews with 29 home care aides in New York City, focused specifically on aides' use of support after client death. Theories of work stress, the social ecological framework, and feminist theories of care informed our research. Our analysis demonstrates aides' extensive reliance on personal sources of support and explores the challenges this can create in their lives and work, and, potentially, for their communities. We also document aides' efforts to cultivate support stemming from their home-based work environments. Home care aides' work stress thus emerges as both an occupational health and a community health issue. While employers should carry responsibility for preventing and mitigating work stress, moving toward health equity for marginalized careworkers requires investing in policy-level and community-level supports to bolster employer efforts, particularly as the home care industry becomes increasingly fragmented and non-standard.

COVID-19 bereavement, depressive symptoms, and binge drinking

The COVID-19 pandemic has caused the death of over half a million Americans, leaving in its wake widespread grief and despair. Using national survey data (n ​= ​1998) and a treatment-weighting strategy, this study examines how COVID-19 bereavement associates with depressive symptoms and binge drinking. After adjustment for non-random exposure to COVID-19 bereavement, I find that respondents who have lost someone close to them to the virus report greater depressive symptomology and more frequent binge drinking. Among essential workers, the loss of a close tie to COVID-19 exacerbates these associations, with bereavement posing stronger effects for depressive symptoms and binge drinking for members of this group. The implications of these findings for the long-term mental health of the bereaved and those most vulnerable to the virus are discussed.

Racial, ethnic, and neighborhood income disparities in childhood posttraumatic stress and grief: Exploring indirect effects through trauma exposure and bereavement

Previous findings suggest that experiences with systems of oppression that disproportionately affect individuals based on race and neighborhood residency (e.g., systemic racism, neighborhood income disadvantage [NID]) can be associated with higher odds of developing psychological problems following traumatic events. Although race/ethnicity and NID residency are often associated, they are separate concepts that play unique roles in mental health outcomes among youth. Residents of Black, Latinx, and income-disadvantaged communities also have an increased risk of exposure to polyvictimization and the loss of multiple loved ones. Studies have not carefully delineated the potential relations between race/ethnicity and NID residency, polyvictimization, accumulated losses, and trauma and grief outcomes in youth. We examined mediation models to investigate whether polyvictimization, the loss of multiple loved ones, and exposure to violent death were potential mechanisms through which race/ethnicity and NID would predict trauma and grief outcomes in youth. Participants (N = 429) included Black (19.9%), Latinx (36.0%), and White (27.3%) children and adolescents who were assessed through a routine baseline assessment at a trauma and grief outpatient clinic. Black youth reported significantly elevated posttraumatic stress and maladaptive grief symptoms through higher polyvictimization and violent death exposure relative to White youth, βs = .06-.12, ps <.001. Latinx identity and NID were positively and directly associated with specific domains of maladaptive grief reactions, βs = .10-.17, ps < .001. If replicated longitudinally, these findings suggest that polyvictimization and violent death exposure may be mechanisms through which Black youth develop more severe traumatic stress and grief reactions.

Racial Differences in Early Parental Death, Midlife Life Problems, and Relationship Strain With Adult Children

OBJECTIVES

Black Americans typically experience the death of a parent earlier in the life course than do non-Hispanic Whites, and early parental death is known to hinder subsequent relationship outcomes. Whether early parental death may contribute to racial differences in midlife family relationships and the role midlife adults' current life problems play remain unexplored.

METHOD

Using multilevel modeling, we examined how timing of parental death is associated with relationship strain with adult children and whether the association differs by midlife adults' life problems in Black (n = 166) and non-Hispanic White (n = 467) families from the Family Exchanges Study.

RESULTS

Losing a parent in childhood was associated with more relationship strain with adult children for Black midlife adults, but not for their non-Hispanic White counterparts. Among the bereaved, earlier timing of parental death was associated with more relationship strain with adult children only for Black midlife adults. In both bereaved and nonbereaved sample, participants' recent physical-emotional problems exacerbated the link between timing of parental death and relationship strain with adult children for Black midlife adults.

DISCUSSION

Experiencing the death of a parent in the early life course can be an added structural disadvantage that imposes unique challenges for Black Americans in midlife. Policies and programs aimed at supporting bereaved children may benefit relationships with their own children later in life, and addressing physical-emotional problems in midlife may be a viable intervention point for those midlife adults who experienced the death of a parent in the early life course.

Sociological contributions to race and health: Diversifying the ontological and methodological agenda

Sociologists have made fundamental contributions to the study of race and health in the United States. They have disrupted biological assumptions of race, uncovered individual and structural factors that drive racial health disparities and explored the effects of racism on health. In recent years, however, with broader shifts towards big data, the work to understand the dynamics between race and health has been increasingly pursued from a quantitative perspective. Often, such analyses isolate intermediary mechanisms to further explain race as a cause of disease. While important, these approaches potentially limit our investigations of underlying assumptions about race and the complexity of this critical social construct. We argue that the resulting dearth of qualitative research on race and health substantially limits the knowledge being produced. After providing an overview of the overwhelming shift towards quantitative methods in the study of race and health, we present three areas of study that would benefit from greater qualitative inquiry as follows: (1) Healthy Immigrant Effect, (2) Maternal Health and (3) End-of-Life Care. We conclude with a call to the discipline to embrace the critical role of qualitative research in exploring the dynamics of race and health in the United States.

Social Inequality and the Future of U.S. Life Expectancy

Despite decades of progress, the future of life expectancy in the United States is uncertain due to widening socioeconomic disparities in mortality, continued disparities in mortality across racial/ethnic groups, and an increase in extrinsic causes of death. These trends prompt us to scrutinize life expectancy in a high-income but enormously unequal society like the United States, where social factors determine who is most able to maximize their biological lifespan. After reviewing evidence for biodemographic perspectives on life expectancy, the uneven diffusion of health-enhancing innovations throughout the population, and the changing nature of threats to population health, we argue that sociology is optimally positioned to lead discourse on the future of life expectancy. Given recent trends, sociologists should emphasize the importance of the social determinants of life expectancy, redirecting research focus away from extending extreme longevity and towards research on social inequality with the goal of improving population health for all.

Race/Ethnicity, Cumulative Midlife Loss, and Carotid Atherosclerosis in Middle-Aged Women

African-American women have elevated rates of cardiovascular disease compared with women of other races or ethnicities, and race/ethnicity-related stressors may play a role. We examined the association between a race/ethnicity-related stressor, midlife loss, and a marker of cardiovascular risk, carotid intima media thickness (IMT), in 1,410 African-American, White, Chinese, and Hispanic women from the Study of Women's Health Across the Nation. Participants were queried about losses annually over 12 years (1996-2013), with IMT assessed in year 12-13 via ultrasound. Linear regression models were used to examine associations between cumulative upsetting losses and IMT, adjusting for covariates. In minimally adjusted models in the full cohort, 3 or more upsetting losses (vs. none) were associated with IMT (β = 0.03, 95% confidence interval (CI): 0.01, 0.05; P = 0.0003). Results were more robust among African-American women (β = 0.042, 95% CI: 0.01, 0.07; P < 0.01) than White (β = 0.014, 95% CI: -0.01, 0.03; P = 0.21), Chinese (β = 0.036, 95% CI: -0.03, 0.10; P = 0.25), or Hispanic (β = 0.036, 95% CI: -0.07, 0.14; P = 0.51) women, although associations among women from racial/ethnic minorities overall were of similar magnitude. Results persisted in fully adjusted models (P for interaction with race/ethnicity = 0.04). Midlife loss may be a pathway through which race/ethnicity influences cardiovascular risk for African-American women and, potentially, Chinese and Hispanic women.

Global burden of maternal bereavement: indicators of the cumulative prevalence of child loss

BACKGROUND

We provide country-level estimates of the cumulative prevalence of mothers bereaved by a child's death in 170 countries and territories.

METHODS

We generate indicators of the cumulative prevalence of mothers who have had an infant, under-five-year-old or any-age child ever die by using publicly available survey data in 89 countries and an indirect approach that combines formal kinship models and life-table methods in an additional 81 countries. We label these measures the maternal cumulative prevalence of infant mortality (mIM), under-five mortality (mU5M) and offspring mortality (mOM) and generate prevalence estimates for 20-44-year-old and 45-49-year-old mothers.

RESULTS

In several Asian and European countries, the mIM and mU5M are below 10 per 1000 mothers yet exceed 200 per 1000 mothers in several Middle Eastern and African countries. Global inequality in mothers' experience of child loss is enormous: mothers in high-mortality-burden African countries are more than 100 times more likely to have had a child die than mothers in low-mortality-burden Asian and European countries. In more than 20 African countries, the mOM exceeds 500 per 1000 mothers, meaning that it is typical for a surviving 45-49-year-old mother to be bereaved.

DISCUSSION

The study reveals enormous global disparities in mothers' experience of child loss and identifies a need for more research on the downstream mental and physical health risks associated with parental bereavement.