Educational Attainment Better Protects African American Women than African American Men Against Depressive Symptoms and Psychological Distress

Mental Health and Black Male Graduate Students

The purpose of this study was to understand how masculinity and race impact mental health among Black male graduate students. A qualitative study using in-depth interviews recruited Black male graduate students enrolled at a private university in the southern United States. Data were collected over zoom and recorded. Interviews were transcribed and the data were analyzed for similar themes. Twenty-nine Black male graduate students 23 to 51 were recruited. Participants reported the three main elements that impacted their mental health were (1) expectations, (2) pressure, and (3) being strong. These findings suggest that colleges need to develop programming to help Black men learn how to handle racial discrimination in positive ways. Additionally, findings also highlight the need for culturally relevant mental health services that let Black men know seeking help is ok and is what men do.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

IMPLICATIONS

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

Immigration Status, Educational Level, and Perceived Discrimination in Europe

BACKGROUND

Multiple studies have been conducted to test the moderating effect of immigration on the positive health results yielded through educational attainment. However, no study has been conducted to examine the role of immigration as a moderator in the association between educational level and perceived discrimination in Europe.

AIM

We aimed to study whether an inverse association exists between educational level and perceived discrimination in European countries and whether immigration status moderates the association between educational level and perceived discrimination.

METHODS

Data from the 10th round of the cross-sectional European Social Survey (ESS) were used in this cross-sectional study. A total of 17,596 participants between 15-90 years old who lived in European countries were included. The independent variable was educational level, a categorical variable, and the dependent variable was perceived discrimination. Immigration status was the moderator, and age and sex were confounders.

RESULTS

Of 17,596 participants, 16,632 (94.5%) were native-born and 964 were immigrants (5.5%). We found that higher levels of educational level were protective against perceived discrimination, which was also found in immigrant participants; however, the effect was weaker.

CONCLUSIONS

This study found that educational level was a protective factor against perceived discrimination. This effect, however, was more robust in the native-born participants than in their immigrant counterparts.

Psychological challenges and related factors of ordinary residents after "7.20" heavy rainstorm disaster in Zhengzhou: a cross-sectional survey and study

BACKGROUND

In 2021, a once-in-a-century heavy rainstorm suddenly attacked Zhengzhou, an important inland city in northern China. However, there have been no studies on the psychological health of disaster-stricken residents. This study is the first to comprehensively report on the mental health status and related factors of local ordinary residents after the heavy rainstorm.

OBJECTIVE

The purpose of this study is to investigate the mental health status and related influencing factors of local ordinary residents after the flood disaster, and to provide reference for government departments to formulate disaster psychological intervention countermeasures based on evidence-driven strategies.

METHODS

The snowball sampling technique was used in this study, and measurement tools of Rainstorm Exposure Questionnaire, Subjective Perception of Rainstorm, Post-Traumatic Stress Disorder Checklist-Civilian version (PCL-C), Depression, Anxiety and Stress Scale-21 (DAS-21) and Chinese version of Social Support Rating Scale (SSRS) were used to evaluate the rainstorm exposure, subjective perception of the rainstorm, psychological symptoms and social support of the disaster-stricken residents within a week after the rainstorm. Logistic regression analysis was used to examine the psychological status and related factors of local residents after the rainstorm disaster.

RESULTS

A total of 469 valid samples were obtained in this study. All the subjects were in the disaster area and experienced the rainstorm personally, with normal intelligence. The statistical results showed that 25.37% people had experienced at least three rainstorm-related stresses, nearly 20.26% people had post-traumatic stress disorder (PTSD) symptoms, and 39.3%, 53.92% and 65.83% people had depression, anxiety and stress symptoms, respectively. Multivariable logistic regression analyses indicated that female (all p < 0.05), the divorced, agricultural workers/farmers (all p < 0.05), students (all p < 0.05), people experiencing at least three rainstorm-related stresses (p < 0.05 or p < 0.01), people with lower satisfaction at the social flood fighting measures (p < 0.05 or p < 0.01) and people with low social support (p < 0.05 or p < 0.01) were all independent risk factors for poor psychological health, and college education or above (p < 0.05 or p < 0.01), the lower degree of worrying about themselves (all p < 0.01), family members (all p < 0.01) and family property (all p < 0.01) were all related to higher psychological health among flood survivors after the disaster.

CONCLUSIONS

Rainstorm could cause local residents to have various degrees of psychological symptoms. This study identified factors associated with the psychological health of disaster-stricken residents, which could be used to develop psychological interventions in improving psychological health of local residents.

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

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

Do preschool teachers in Southwest China need more mental health education? An online cross-sectional survey 1 year after the COVID-19 pandemic

This study intended to explore the current status of psychological problems of preschool teachers in Southwest China 1 year after the COVID-19 pandemic and to assess the association between mental health education and psychological problems and symptoms of psychopathology. A total of 614 preschool teachers from Southwest China were enrolled to complete the questionnaires of the Chinese Symptom Checklist (SCL-90). Notably, 60% of the respondents reported psychological distress with GSI T-scores ≥ 63, especially the high score was reported on obsessive-compulsive disorder, interpersonal sensitivity, and phobic anxiety. Although less than half of the respondents have received mental health education last year, the teachers who received the mental health education reported lower GSI T-scores(β = −1.303, 95% CI: −2.208, −0.397). The results demonstrated the significance of constructing the education of promoting mental health of preschool teachers, and enlightening government or managers of kindergartens to relieve the psychological problems of preschool teachers through mental health education, especially for those with the pressure of overtime. It is recommended that local governments or kindergartens should organize more mental health education for kindergarten teachers to improve their mental health as well as their teaching professionalism.

Future Directions on BIPOC Youth Mental Health: The Importance of Cultural Rituals in the COVID-19 Pandemic

Culture plays an important role in the development of mental health, especially during childhood and adolescence. However, less is known about how participation in cultural rituals is related to the wellbeing of youth who are Black, Indigenous, and People of Color (BIPOC), and part of the Global Majority. This is crucial amid the COVID-19 pandemic, a global event that has disproportionally affected BIPOC youth and disrupted participation in rituals. The goal of this paper is to promote advances in clinical child and adolescent psychology focused on rituals. We begin by defining culture and rituals and examining their role on development. We illustrate these issues with the Lunar New Year in China, Maya rituals in México, Ramadan in Turkey, and Black graduations and Latinx funerals in the United States. We discuss how the pandemic has affected participation in these rituals and their potential impact on BIPOC children and adolescents' mental health. We propose future directions and recommendations for research.

Structural racism and the education gradient for early all-cause mortality

There are clear connections between education achieved and health over the course of a lifetime, with higher education achievement being associated with better health. However, the association between education and mortality have differed by race, with minoritized populations reaping fewer benefits from education attained. This paper aims to understand the moderating effect of structural racism (measured at the state level) on the association between education and all-cause early mortality for Black and White participants. We utilize a nationally representative longitudinal sample of youth (NLSY97), and estimates of structural racism for each state through measures of political participation, employment and job status, education attainment ratios, and judicial treatment. Random effects models were then utilized to compare associations between Black and White participants, and assess the association of education on early mortality. Results indicate significant, yet nuanced findings in each of the models assessed suggesting that Black and White participants experienced diminished returns of education on the probability of early mortality. Findings support previous research suggesting that structural racism is costing all citizens, but is especially harmful for minoritized populations.

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

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

Cross-sectional investigation and correlation analysis of psychology of college students returning to campus after COVID-19 lockdown lift

OBJECTIVE

To conduct a large cross-sectional survey of the mental health of college students during the recovery period of the COVID-19 epidemic.

METHODS

Symptom Checklist 90 (SCL-90) and COVID-19 questionnaire were used to investigate the overall mental health level and cognition of epidemic situation of college students in seven colleges and universities in Shaanxi Province.

RESULTS

(1) In the recovery period of COVID-19 epidemic, college students still had psychological and somatic symptoms such as obsessive-compulsive disorder, interpersonal sensitivity, anxiety, hostility, and poor appetite or insomnia; (2) female college students, science and engineering college students, freshmen and senior graduates, and some ethnic minority college students were all groups with psychological symptoms; (3) the psychological status of college students was related to their perception of COVID-19 epidemic, and the more knowledge about epidemic prevention and control, the more confident they were in overcoming the epidemic, and the milder the psychological symptoms.

CONCLUSION

College students still have some mental health problems in the recovery period of COVID-19 epidemic, which should be paid attention to by education authorities and colleges and universities.

Educational Attainment and Psychological Distress Among Working-Age Adults in the United States

This study builds on a growing body of literature analyzing the education-health gradient across detailed educational categories, which documents that US working-age adults who attended college but did not earn a bachelor's degree report equal or worse health than adults with a high school diploma. This is known as the "anomaly" in the education-health gradient. The purpose of this study is to test whether this pattern extends to measures of serious psychological distress (SPD) and individual symptoms by using data from the National Health Interview Survey (NHIS, 1997-2018) and a series of logistic regression models. We find that the anomaly in the education-health gradient is present for a summary measure of SPD as well as for five of the six symptoms that make up this measure. The exception was reporting feeling sad most or all the time during the last month, where adults with "some college" were found to have lower odds than those with a high school diploma. Further stratified analysis by sex revealed that this result for feeling sad was driven by women. In terms of associate degrees, our models show that adults with a vocational/technical associate degree have statically similar odds of SPD and reporting four out of six symptoms (exceptions were feeling hopeless and sadness), while those with an academic associate degree have significantly lower odds in all outcomes. The robustness of the models used is supported by an extensive sensitivity analysis. Overall, we find evidence of the anomaly in the education-health gradient in SPD and individual symptoms of psychological distress at the sub-baccalaureate level, adding to previous studies that document the anomaly in markers of physiological dysregulation, health conditions, vision problems, functional limitations, and pain.

Understanding the benefits of different types and timing of education for mental health: A sequence analysis approach

OBJECTIVES

Individuals increasingly experience delays or interruptions in schooling; we evaluate the association between these non-traditional education trajectories and mental health.

METHODS

Using year-by-year education data for 7,501 National Longitudinal Survey of Youth 1979 participants, ages 14-48 (262,535 person-years of education data), we applied sequence analysis and a clustering algorithm to identify educational trajectory groups, incorporating both type and timing to credential. Linear regression models, adjusted for early-life confounders, evaluated relationships between educational trajectories and mental health component scores (MCS) from the 12-item short form instrument at age 50. We evaluated effect modification by race, gender, and race by gender.

RESULTS

We identified 24 distinct educational trajectories based on highest credential and educational timing. Compared to high school (HS) diplomas, < HS (beta=-3.41, 95%CI:-4.74,-2.07) and general educational development credentials (GEDs) predicted poorer MCS (beta=-2.07,95%CI:-3.16,-0.98). The following educational trajectories predicted better MCS: some college immediately after High School (beta=1.52, 95%CI:0.68,2.37), Associate degrees after long interruptions (beta=1.73, 95%CI:0.27,3.19), and graduate school soon after Bachelor's completion (beta=1.13, 95%CI:0.21,2.06). Compared to White men, Black women especially benefited from educational credentials higher than HS in predicting MCS.

CONCLUSIONS

Both type and timing of educational credential predicted mental health. Black women's mental higher especially benefited from higher educational credentials.

The Compounded Burden of Poverty on Mental Health for People with Disabilities

Using 2008-2017 National Health Interview Survey data (N = 127,973), we investigated the relationship between income and psychological distress, measured by the Kessler 6 (K6) Scale (range 0-24), net of education, employment, and other sociodemographic characteristics. Regression models allowed the association to differ by disability status and number of disabilities. Lower income predicted higher psychological distress for those with and without disabilities. However, the adverse association was stronger among people with disabilities. Compared to those with incomes at least four times the poverty threshold, poor individuals with disabilities scored 2.81 (95% CI = 2.55,3.67) points higher on the K6 Scale versus 0.58 (95% CI = 0.48,0.69) points higher for those without disabilities. Differences in associations by number of disabilities were not statistically significant. Nonetheless, those with multiple disabilities were still at increased risk of distress because they were disproportionately poor. People with disabilities who are poor are particularly disadvantaged and should be prioritized in outreach efforts.

Money Protects White but Not African American Men against Discrimination: Comparison of African American and White Men in the Same Geographic Areas

To compare African American (AA) and non-Hispanic White men living in same residential areas for the associations between educational attainment and household income with perceived discrimination (PD). The National Survey of American Life (NSAL), a nationally representative study, included 1643 men who were either African American (n = 1271) or non-Hispanic White (n = 372). We compared the associations between the two race groups using linear regression. In the total sample, high household income was significantly associated with lower levels of PD. There were interactions between race and household income, suggesting that the association between household income and PD significantly differs for African American and non-Hispanic White men. For non-Hispanic White men, household income was inversely associated with PD. For African American men, however, household income was not related to PD. While higher income offers greater protection for non-Hispanic White men against PD, African American men perceive higher levels of discrimination compared to White males, regardless of income levels. Understanding the role this similar but unequal experience plays in the physical and mental health of African American men is worth exploring. Additionally, developing an enhanced understanding of the drivers for high-income African American men’s cognitive appraisal of discrimination may be useful in anticipating and addressing the health impacts of that discrimination. Equally important to discerning how social determinants work in high-income African American men’s physical and mental health may be investigating the impact of the mental health and wellbeing of deferment based on perceived discrimination of dreams and aspirations associated with achieving high levels of education and income attainment of Black men.

THOSE LEFT BEHIND: Socioeconomic Predictors and Social Mediators of Psychological Distress among Working-age African Americans in a Post-industrial City

While the socioeconomic status (SES)-psychological distress gradient is well-documented in the social science literature, less attention has been devoted to how this relationship varies within sociodemographic subgroups. I contribute to this small but growing literature by first examining the relationship between multiple dimensions of SES and two measures of psychological distress (depression and anxiety) among working-aged African Americans. I then test whether three social mediators explain the SES-psychological distress relationship, and whether gender modifies these associations and/or the social mediators that shape them. To address these aims, I analyze two waves of population-representative data from the Detroit Neighborhood Health Study (N=685). Data were collected between 2008 and 2010 in the wake of the Great Recession. I utilize structural equation modeling with latent variables to assess these relationships, and test indirect and conditional effects to detect the presence of mediation and/or moderation, respectively. Findings revealed associations between higher total household income and lower levels of depression/anxiety, as well as unemployment and increased depression/anxiety among working age African Americans. Furthermore, higher educational attainment was associated with reduced anxiety, but not depression, in this population. Gender moderated these findings such that unemployment was associated with higher levels of depression/anxiety among women but not men. I also found that trauma mediated the relationship between unemployment and depression/anxiety as well as educational attainment and anxiety. Gender, however, moderated the association between unemployment and depression/anxiety via traumatic events such that the relationship was stronger among women than men. Collectively, these findings contribute to our limited understanding of African Americans' mental health and underscore the importance of how both socioeconomic forces and life course experiences with traumatic events contribute to poor mental health among this population.

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

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

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Subjective Socioeconomic Status and Children's Amygdala Volume: Minorities' Diminish Returns

Considerable research has suggested that low socioeconomic status (SES) negatively influences brain structure, including but not limited to decreased amygdala volume. Considering race and ethnicity as sociological rather than biological constructs, this study was built on minorities' diminished returns (MDRs) to test if the effects of family SES on the total amygdala volume is weaker for black and Latino children than white and non-Latino children. We borrowed data from the Adolescent Brain Cognitive Development (ABCD) study, a national multi-center brain imaging investigation of childhood brain development in the US. The total sample was 9380 9-10-year-old children. The independent variables were subjective family SES and parental education. The primary outcome was total amygdala volume. High subjective SES and parental education were independently associated with larger total amygdala size. The association between high subjective SES and larger total amygdala volume was less pronounced for black and Latino children than white and non-Latino children. For American children, family SES has unequal effects on amygdala size and function, a pattern that is consistent with MDRs. This result suggests that SES loses some of its expected effects for racial and ethnic minority families.

Prostate Cancer Screening in Middle-Aged and Older American Men: Combined Effects of Ethnicity and Years of Schooling

BACKGROUND

Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. The role of MDRs as a source of ethnic health disparities is, however, still unknown.

OBJECTIVES

The current study had two aims: first, to explore the association between years of schooling and having taken a prostate-specific antigen (PSA) test among men in the US, and second, to explore ethnic differences in this association.

METHODS

This study was a secondary analysis of data from the National Health Interview Survey (NHIS-2015). The data of 5,053 men aged 55 years or older who were either Latino, non-Latino, African-American, or White were analyzed. Years of schooling was the independent variable. The dependent variable was taking a PSA test sometime during one's lifetime. Age, region, and employment were the control variables. Ethnicity was the focal moderating variable. Binary logistic regression was used for data analysis.

RESULTS

A higher number of years of schooling was associated with higher odds of having taken a PSA test, net of all confounders. Ethnicity showed a significant statistical interaction with years of schooling on having taken a PSA test. This interaction was suggestive of a smaller slope for Latino men than non-Latino men. White and African American men did not show differential effects of years of schooling on having taken a PSA test.

CONCLUSION

Similar to the MDRs patterns in other domains, non-Latino White men show more health gain from their years of schooling than Latino men. Highly educated Latino men still need programs to encourage their use of prostate cancer screening.

Psychological symptoms of ordinary Chinese citizens based on SCL-90 during the level I emergency response to COVID-19

The World Health Organization (WHO) has declared that the Corona Virus (COVID-19) has become a global pandemic. This study aimed to investigate the psychological symptoms of ordinary Chinese citizens during the Level I Emergency Response throughout China. From January 31 to February 2 2020, an online questionnaire, Symptom Checklist 90 (SCL-90) was designed, and differences in GSI T-scores among subgroups were examined by ANOVA. Based on a cut-off point of the GSI T-scores of 63, the overall sample was divided into high and low-risk groups. of the 1,060 participants investigated in China, more than 70% of them have moderate and higher level of psychological symptoms specifically elevated scores for obsessive compulsion, interpersonal sensitivity, phobic anxiety, and psychoticism. There were no significant differences between males and females. Those who were of over 50 years old, had an undergraduate education and below, were divorced or widowed, and agricultural workers had significantly more symptoms. However, significantly more minors and medical staff were in the high-risk group. These results show that COVID-19 has a significant adverse socio-psychological influence on ordinary citizens. Therefore, governments should equip psychological health departments and pay attention to the people who are in high-risk groups, providing psychological interventions and assistance.

Combined Effects of Race and Educational Attainment on Physician Visits Over 24 Years in a National Sample of Middle-Aged and Older Americans

Background

The literature on Minorities' Diminished Returns (MDRs) have shown worse than expected health of the members of racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational attainment on preventive care and disease management in highly educated racial and ethnic minorities.

Objectives

The current study explored the racial and ethnic differences in the effect of baseline educational attainment on % adherance to the routine physician visits among middle-aged and older adults in the US.

Methods

This is a prospective study with 24 years of follow up. The Health and Retirement Study (HRS: 1992-2016) included 10 880 middle-aged and older adults who were Hispanic, non-Hispanic, Black or White. The independent variable was educational attainment. The dependent variable was adherance to the routine physician visits (%). Age, gender, marital status, income, health behaviors (smoking and drinking) and health (depression, self-rated health, and chronic diseases) were the covariates. Race and ethnicity were the focal moderators. Linear regression was used for data analysis.

Results

Overall, higher educational attainment was associated with higher % of adherance to the routine physician visits over the course of follow-up, net of all confounders. Race showed a significant statistical interaction with educational attainment suggesting of a smaller effect of high education attainment on % adherance to the routine physician visits for Black than White middle-aged and older adults. A similar interaction could not be found for the comparison of Hispanic and non-Hispanic middle-aged and older adults.

Conclusion

Educational attainment is associated with a larger increase in preventive and disease management doctor visits for White than Black middle-aged and older adults. This is a missed opportunity to improve the health of highly educated middle-aged and older adults. It is not race/ethnicity or class that shapes health behaviors but race/ethnicity and class that shape people's pro-health behaviors. At least some of the racial health disparities is not due to low SES but diminished returns of SES.

Socioeconomic Status and Current Cigarette Smoking Status: Immigrants' Diminished Returns

Introduction

Although socioeconomic status (SES) resources influence population and individual health behaviors, socially marginalized groups gain significantly less health from their SES indicators, such as education and income, compared to the socially privileged groups. This pattern is called marginalization-related diminished returns (MDRs). However, most of the MDRs literature is derived from studies that have defined marginalization based on race and ethnicity. As a result, more research is needed on MDRs due to immigration. To extend what is known about MDRs due to immigration, the current study compared a national sample of immigrants and non-immigrants for the effects of education and income on current cigarette smoking of adults in the United States.

Methods

This is a cross-sectional study. The 2015 National Health Interview Survey (NHIS) enrolled 14,149 individuals who were either immigrants (n=1977; 14.0%) or non-immigrants (n=12,166; 86.0%). The independent variables (IV) were education and income that were treated as categorical variables. The dependent variable was current cigarette smoking. Age, gender, race, ethnicity, marital status, employment, and region were confounders. Immigration was the moderator. Logistic regression was used for data analysis.

Results

High education and income were associated with lower odds of current cigarette smoking. However, immigration showed significant statistical interactions with both education and income. These interactions were suggestive of smaller protective effects of high education and income on current cigarette smoking for immigrant than non-immigrant adults.

Conclusion

In line with the MDRs, the effects of education and income on tobacco use is weaker for immigrant than non-immigrant adults.

Diminished Returns of Educational Attainment on Heart Disease among Black Americans

Background

Socioeconomic Status (SES) indicators, such as educational attainment, are social determinants of heart disease. Marginalization related Diminished Returns (MDRs) refer to smaller health benefits of high SES for racial and ethnic minorities compared to the majority group. It is still unknown, however, if MDRs also apply to the effects of education on heart disease.

Purpose

Using a nationally representative sample, we explored racial/ethnic variation in the link between educational attainment and heart disease among American adults.

Methods

We analyzed data (n=25,659) from a nationally representative survey of American adults in 2013. The first wave of the Population Assessment of Tobacco and Health - Adult (PATH-Adult) study was used. The independent variable was education (college graduate, high school graduate, less than a high school diploma). The dependent variable was any heart disease. Age and gender were the covariates. Race, as well as ethnicity, were the moderators. Logistic regressions were used to analyze the data.

Results

Individuals with higher educational attainment had lower odds of heart disease. Race and ethnicity showed statistically significant interactions with education, suggesting that the protective effect of higher education on reducing odds of heart disease was smaller for Hispanic and Black people than for non-Hispanic and White individuals.

Conclusion

Education reduces the risk of heart disease better among non-Hispanic Whites than for Hispanics and Blacks. Therefore, we may expect a disproportionately higher than expected risk of heart disease in Hispanics and Blacks with high educational attainment. Future research should test if the presence of high levels of environmental and behavioral risk factors contribute to the high risk of heart disease in highly educated Black and Hispanic Americans. Policymakers should not reduce health inequalities to just gaps in SES because disparities are present across SES levels, with high SES Blacks and Hispanics remaining at risk of health problems.

Combined Effects of Ethnicity and Education on Burden of Depressive Symptoms over 24 Years in Middle-Aged and Older Adults in the United States

Ethnicity and educational attainment are among the major social determinants of depression in the general population. While high education credentials protect individuals against depressive symptoms, this protection may be weaker for ethnic minority groups such as Hispanic Whites compared to the majority group (non-Hispanic Whites). Built on marginalization-related diminished returns (MDRs), the current study used 24-year follow-up data from a nationally representative sample of middle-aged and older adults to explore ethnic variation in the protective effect of education levels against the burden of depressive symptoms over time. Data for this analysis were borrowed from the Health and Retirement Study (HRS 1992-ongoing), a nationally representative longitudinal study. HRS followed 8314 middle-aged and older adults (50+ years old) for up to 24 years. From this number, 763 (9.2%) were Hispanic White, and 7551 (90.8%) were non-Hispanic White Americans. Education level was the independent variable. We had two outcomes. Firstly, using cluster analysis, individuals were categorized to low- and high-risk groups (regarding the burden of depressive symptoms over 24 years); secondly, average depressive symptoms were observed over the 24 years of follow up. Age and gender were the covariates. Ethnicity was the moderator. Linear and logistic regression were used for analysis. Logistic regression showed that, overall, high educational credentials reduced the odds of chronic depressive symptoms over the 24 years of follow-up. Linear regression also showed that higher years of education were associated with lower average depressive symptoms over time. Both models showed statistically significant interactions between ethnicity and graduation, indicating a smaller protective effect of high education against depressive symptoms over the 24 years of follow-up time among Hispanic with respect to non-Hispanic White people. In line with the MDRs, highly educated Hispanic White Americans remain at high risk for depressive symptoms, a risk that is unexpected given their education. The burden of depressive symptoms, however, is lowest for highly educated non-Hispanic White Americans. Policies that exclusively focus on equalizing educational gaps across ethnic groups may fail to eliminate the ethnic gap in the burden of chronic depressive symptoms, given the diminished marginal health return of education for ethnic minorities. Public policies must equalize not only education but also educational quality across ethnic groups. This aim would require addressing structural and environmental barriers that are disproportionately more common in the lives of ethnic minorities across education levels. Future research should test how contextual factors, residential segregation, school segregation, labor market practices, childhood poverty, and education quality in urban schools reduce the health return of educational attainment for highly educated ethnic minorities such as Hispanics.

Educational Attainment Better Increases the Chance of Breast Physical Exam for Non-Hispanic Than Hispanic American Women: National Health Interview Survey

Background

The Minorities' Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites.

Objective

The current study explored the racial and ethnic differences in the association between educational attainment and breast physical exam (BPE) among women in the U.S.

Methods

The National Health Interview Survey (NHIS 2015) included 12 510 women who were Hispanic or non-Hispanic Black or White people. The independent variable was the level of educational attainment. The dependent variable was lifetime BPE. Age, region, marital status, and employment were the covariates. Race and ethnicity were the focal moderators. Logistic regressions were used for data analysis.

Results

Overall, higher educational attainment was associated with higher odds of BPE, net of all confounders (odds ratio [OR] = 1.11, 95% CI = 1.09-1.13). Ethnicity showed a significant statistical interaction with educational attainment on BPE (OR = 0.96, 95% CI = 0.93-1.00), which was suggestive of a smaller effect of high education attainment on BPE for Hispanic than non-Hispanic women. The same interaction could not be found for the comparison of White and Black women (OR = 0.98, 95% CI =0.94-1.02).

Conclusion

In line with other domains, non-Hispanic White women show a larger amount of health gain from their educational attainment than Hispanic women. It is not ethnicity or class but ethnicity and class that shapes how people engage in pro-health behaviors. This result may help hospitals and healthcare systems to better reduce health disparities in their target populations.

Income and Mental Well-Being of Middle-Aged and Older Americans: Immigrants' Diminished Returns

Introduction

Although income is among the major social determinants of mental health of middle-aged and older individuals, socially marginalized groups gain less health from their income and other socioeconomic status (SES) resources compared to socially privileged groups. This pattern is called marginalization-related diminished returns (MDRs). Most of the existing knowledge on MDRs, however, has been derived from studies that have defined marginalization based on race, ethnicity, or sexual orientation. As a result, very limited information exists on whether similar MDRs can be observed for middle-aged and older immigrants or not. Building on the MDRs framework, this study compared a national sample of immigrants and non-immigrants for the effects of income on the mental well-being of middle-aged and older adults in the United States.

Methods

This is a cross-sectional study. The 2015 National Health Interview Survey (NHIS) enrolled 14 149 middle-aged and older individuals who were either immigrants (n=1977; 14.0%) or non-immigrants (n=12 166; 86.0%). The independent variable (IV) was income that was treated as a continuous variable. The dependent variable was mental well-being, also treated as a continuous variable. Age, gender, race, ethnicity, education, marital status, employment, self-rated health, obesity, and region were confounders. Immigration (nativity status) was the moderator. Logistic regression was applied for data analysis.

Results

High income was associated with higher odds of good mental well-being in middle-aged and older adults. However, immigration showed a significant statistical interaction with income, which was suggestive of a smaller protective effect of high income on mental well-being for immigrant than non-immigrant middle-aged and older adults.

Conclusion

In line with MDRs, the association between income and mental well-being is weaker for immigrant than non-immigrant middle-aged and older adults. There is a need to help high income immigrants secure health outcomes similar to those of non-immigrants. Such changes may require bold and innovative economic, public, and social policies that help immigrants more effectively translate their income and socioeconomic resources into tangible outcomes such as mental well-being.

Race, Ethnicity, Socioeconomic Status, and Chronic Lung Disease in the U.S

BACKGROUND

Higher socioeconomic status (SES) indicators such as educational attainment and income reduce the risk of chronic lung diseases (CLDs) such as Chronic Obstructive Pulmonary Disease (COPD), emphysema, chronic bronchitis, and asthma. Marginalization-related Diminished Returns (MDRs) refer to smaller health benefits of high SES for marginalized populations such as racial and ethnic minorities compared to the socially privileged groups such as non-Hispanic Whites. It is still unknown, however, if MDRs also apply to the effects of education and income on CLDs.

PURPOSE

Using a nationally representative sample, the current study explored racial and ethnic variation in the associations between educational attainment and income and CLDs among American adults.

METHODS

In this study, we analyzed data (n = 25,659) from a nationally representative survey of American adults in 2013 and 2014. Wave one of the Population Assessment of Tobacco and Health (PATH)-Adult study was used. The independent variables were educational attainment (less than high school = 1, high school graduate = 2, and college graduate =3) and income (living out of poverty =1, living in poverty = 0). The dependent variable was any CLDs (i.e., COPD, emphysema, chronic bronchitis, and asthma). Age, gender, employment, and region were the covariates. Race and ethnicity were the moderators. Logistic regressions were fitted to analyze the data.

RESULTS

Individuals with higher educational attainment and those with higher income (who lived out of poverty) had lower odds of CLDs. Race and ethnicity showed statistically significant interactions with educational attainment and income, suggesting that the protective effects of high education and income on reducing odds of CLDs were smaller for Blacks and Hispanics than for non-Hispanic Whites.

CONCLUSIONS

Education and income better reduce the risk of CLDs among Whites than Hispanics and Blacks. That means we should expect disproportionately higher than expected risk of CLDs in Hispanics and Blacks with high SES. Future research should test if high levels of environmental risk factors contribute to the high risk of CLDs in high income and highly educated Black and Hispanic Americans. Policy makers should not reduce health inequalities to SES gaps because disparities sustain across SES levels, with high SES Blacks and Hispanics remaining at risk of health problems.

Understanding America: Unequal Economic Returns of Years of Schooling in Whites and Blacks

BACKGROUND

Higher schooling is associated with higher economic wellbeing. Marginalization-related Diminished Returns (MDRs) framework, however, refers to smaller returns of schooling for non-Hispanic Blacks (NHBs) compared to non-Hispanic Whites (NHWs).

AIM

Using a national sample of American adults, the current study compared NHBs and NHWs for the effects of each incremental increase in the years of schooling (gradient of educational level) on economic wellbeing of American adults.

METHODS

Data came from the Understanding America Study (UAS), a national online survey with a nationally representative sample. A total of 5715 adults (18+ years old) were included. From this number, 4,826 (84.4%) were NHWs, and 889 (15.6%) were NHBs. Years of schooling was the independent variable. Economic wellbeing was the main outcome. Age and gender were the covariates. Race was the moderator.

RESULTS

Overall, each additional year of schooling was associated with higher economic wellbeing, net of age, and gender. A statistically significant interaction was found between race and years of schooling on the outcome, indicating a smaller boosting effect of any incremental increase in the years of education on the economic wellbeing of NHBs compared to NHWs.

CONCLUSION

In line with MDRs, highly educated Black people experience low economic wellbeing. The MDRs of education on economic wellbeing may be why highly educated, and middle-class Black Americans still report poor health. Policy solutions should address multi-level causes of MDR-related health disparities.

Parental Education and Nucleus Accumbens Response to Reward Anticipation: Minorities' Diminished Returns

Background

Considerable research has documented the effects of race and socioeconomic status (SES) on reward-seeking behaviors; however, less is known about the multiplicative effects of race and family SES on brain response to reward anticipation. Marginalization-related Diminished Returns (MDRs) suggest that family SES would show weaker effects on brain development of children in non-White families than in White families.

Objective

To test race by SES variation in Nucleus Accumbens (NAcc) response to reward anticipation (NAcc-RA) among American children.

Methods

For this cross-sectional analysis, data came from the Adolescent Brain Cognitive Development (ABCD) study which included 6,419, 9-10 year old children. The independent variable was parental education. The moderator was race. The primary outcome was the right NAcc-RA. Age, sex, ethnicity, household income, and family structure were the covariates. We used mixed effects regression models that adjusted for the nested nature of the ABCD data.

Results

While high parental education was associated with a higher amount of right NAcc-RA, this effect was stronger for White than non-White children. This finding was evident in the observed interactions between race and parental education on the right NAcc-RA.

Discussion

For American children, NAcc-RA is not shaped by race or family SES, but by their intersection. As a result of the interaction between race and SES (diminished return of SES for non-Whites), middle-class racial minority children may remain susceptible to high-risk behaviors. Disparities in high-risk behaviors in children should not be reduced to economic disparities. Structural inequalities may reduce the return of SES resources for non-White families.

Diminished Health Returns of Educational Attainment Among Immigrant Adults in the United States

Objectives: Marginalization-related diminished returns (MDRs) refer to weaker health effects of educational attainment for socially marginalized groups compared to the socially privileged groups. Most of the existing literature on MDRs, however, has focused on marginalization due to race, ethnicity, and sexual orientation. Thus, very limited information exists on MDRs of educational attainment among immigrant populations in the United States. Aims: Building on the MDRs framework and using a nationally representative sample of US adults, we compared immigrant and native-born adults for the effects of educational attainment on psychological distress, self-rated health (SRH), and chronic diseases (CDs). Methods: The 2015 National Health Interview Survey (NHIS) has enrolled 33,672 individuals who were either immigrant (n = 6,225; 18.5%) or native born (n = 27,429; 81.5%). The independent variable (IV) was educational attainment, which was treated as a categorical variable. The dependent variables included psychological distress, SRH, and CDs, all of which were dichotomous variables. Age, gender, race, ethnicity, and region were confounders. Immigration (nativity status) was the moderator. Results: Higher educational attainment was associated with lower odds of psychological distress, poor SRH, and CDs. However, immigration showed a significant statistical interaction with college graduation on all outcomes, which were suggestive of smaller protective effects of college graduation on psychological distress, poor SRH, and CDs for immigrant than native-born adults. Conclusions: In the US, the associations between educational attainment and psychological distress, SRH, and CDs are all weaker for immigrant than native-born adults. To prevent health disparities, it is essential to decompose health inequalities that are due to low educational attainment from those that are due to diminished returns of educational attainment (i.e., MDRs). There is a need to help highly educated immigrant adults secure positive health outcomes, similar to their native-born counterparts. Such changes may require bold and innovative economic, public, and social policies that help immigrant adults to more effectively mobilize their educational attainment to secure tangible outcomes. Elimination of health disparities in the US requires efforts that go beyond equalizing access to education.

Sex Differences in the Impact of Racial Discrimination on Mental Health Among Black Americans

PURPOSE OF REVIEW

Greater racial discrimination is associated with poorer mental health among Black Americans; yet, there remains an incomplete understanding of sex differences in exposure to racial discrimination, and further, of how sex differences in coping with racial discrimination may heighten or diminish risk for poorer mental health.

RECENT FINDINGS

Black men may experience greater exposure to both structural and communal forms of racial discrimination, whereas Black women may face both a wider range of potential sources, as well as encounter greater variability in the subjective experience of racial discrimination. For both Black women and men, racial discrimination may be similarly associated with maladaptive coping strategies (i.e., emotional eating, rumination) that also are linked to poorer mental health; however, emerging findings suggest that mindfulness may partially buffer these deleterious effects. Overall, the recent literature reveals mixed findings with respect to sex differences in the experience and negative mental health impact of racial discrimination. Despite this heterogeneity, evidence documents sex differences in the settings, type, and qualitative experience of racial discrimination among Black Americans. Additionally, growing evidence indicating that racial discrimination is associated with physiological markers of stress reactivity and psychopathology risk further bolsters its characterization as a unique form of chronic stress among Black Americans and other minority groups in the USA.

Pain Intensity among Community-Dwelling African American Older Adults in an Economically Disadvantaged Area of Los Angeles: Social, Behavioral, and Health Determinants

BACKGROUND

Although social, behavioral, and health factors influence prevalence and intensity of pain, very few studies have investigated correlates of pain among economically disadvantaged older African American (AA) adults.

OBJECTIVE

This study explored social, behavioral, and health correlates of pain intensity among community-dwelling AA older adults in an economically disadvantaged area of Los Angeles.

METHODS

A cross-sectional study on 740 AA older adults (age ≥ 55 years) was conducted in South Los Angeles between 2015 and 2018. Exploratory variables were age, gender, educational attainment, financial difficulties, living alone, marital status, smoking, drinking, pain-related chronic medical conditions (CMCs), and depressive symptoms. Dependent variable was pain intensity. Linear regression was used for data analysis.

RESULTS

Age, financial difficulties, living alone, smoking, pain-related chronic medical conditions, and depressive symptoms were associated with pain intensity. Individuals with lower age, higher financial difficulties, those who lived alone, those with a higher number of pain-related chronic medical conditions, more depressive symptoms, and nonsmokers reported more pain intensity. Gender, educational attainment, marital status, and drinking were not associated with pain intensity.

CONCLUSION

The results may help with the health promotion of economically disadvantaged AA older adults in urban areas.

Protective Effects of Educational Attainment Against Cigarette Smoking; Diminished Returns of American Indians and Alaska Natives in the National Health Interview Survey

Background

Although educational attainment is protective against health risk behaviors such as smoking, Minorities' Diminished Returns theory posits that these protective effects are smaller for ethnic minority than the majority groups.

Aims

compare the effects of educational attainment on smoking status of American Indian Alaska Native (AIAN) and White adults.

Methods

Data came from the National Health Interview Survey (NHIS - 2015). A total number of 21114 individuals entered our analysis. The independent variable was years of schooling. The dependent variable was current smoking status. Age, gender, region, marital status, and employment were covariates. Ethnicity was the moderator.

Results

Overall, educational attainment was inversely associated with current smoking. Ethnicity showed a significant interaction with educational attainment that was suggestive that the protective effects of educational attainment against smoking is smaller for AIAN than Whites.

Conclusions

In the United States, while educational attainment helps individuals stay healthy by avoiding high risk behaviors such as smoking, this effect is smaller for AIANs than Whites. The result is additional risk of smoking in highly educated AIANs. To reduce ethnic disparities I tobacco use, it is important to go beyond SES inequalities and investigate why high SES ethnic minorities remain at high risk of tobacco use.

Depressive Symptoms among Economically Disadvantaged African American Older Adults in South Los Angeles

BACKGROUND

Although social, behavioral, and health factors correlate with depressive symptoms, less is known about these links among economically disadvantaged African American (AA) older adults.

OBJECTIVE

To study social, behavioral, and health correlates of depressive symptoms among economically disadvantaged AA older adults.

METHODS

This survey was conducted in South Los Angeles between 2015 and 2018. A total number of 740 AA older adults (age ≥55 years) were entered to this study. Independent variables were gender, age, educational attainment, financial difficulties, living alone, marital status, smoking, drinking, chronic medical conditions (CMCs), and pain intensity. The dependent variable was depressive symptoms. Linear regression model was used to analyze the data.

RESULTS

Age, financial difficulties, smoking, CMCs, and pain intensity were associated with depressive symptoms. Gender, educational attainment, living arrangement, marital status, and drinking were not associated with depressive symptoms.

CONCLUSION

Factors such as age, financial difficulties, smoking, CMCs, and pain may inform programs that wish to screen high risk economically disadvantaged AA older adults for depressive symptoms.

Unequal Associations between Educational Attainment and Occupational Stress across Racial and Ethnic Groups

Background: Although other mechanisms are also involved, at least one reason high educational attainment (EA) is associated with better health is lower employment stress in individuals with high EA. Minorities’ Diminished Returns, however, refer to the smaller protective health effects of EA for racial- and ethnic-minority individuals, particularly African Americans (AAs) and Hispanics, as compared to Whites. We are, however, not aware of many studies that have explored differential associations between EA and work-related stress across racial and ethnic groups. Aims: We aimed to compare racial and ethnic groups for the association between EA and occupational stress in a national sample of American adults. Methods: The National Health Interview Survey (NHIS 2015), a cross-sectional survey, included 15,726 employed adults. Educational attainment was the independent variable. Occupational stress was the outcome. Race and ethnicity were the moderators. Age, gender, number of jobs, and years in the job were the covariates. Results: Overall, higher EA was associated with lower levels of occupational stress. Race and ethnicity both interacted with EA, suggesting that the association between high EA and reduced occupational stress is systemically smaller for AAs and Hispanics than it is for Whites. Conclusions: In the United States, race and ethnicity limit the health gains that follow EA. While EA helps individuals avoid environmental risk factors, such as occupational stress, this is more valid for non-Hispanic Whites than AAs and Hispanics. The result is additional physical and mental health risks in highly educated AAs and Hispanics. The results are important, given racial and ethnic minorities are the largest growing section of the US population. We should not assume that EA is similarly protective across all racial and ethnic groups. In this context, EA may increase, rather than reduce, health disparities.

Race, Educational Attainment, and E-Cigarette Use

BACKGROUND

Although higher educational attainment lowers high-risk behaviors such as substance use, according to the Minorities' Diminished Returns theory, the effect of educational attainment may be smaller for Blacks than Whites.

AIMS

To explore the racial differences in the link between educational attainment and electronic cigarettes (e-cigarettes).

METHODS

We used the Health Information National Trends Survey (HINTS) data. This national survey was conducted in 2017 and included 2,277 American adults composed of 1,868 White and 409 Black individuals. Educational attainment was the independent variable. E-cigarette use (lifetime) was the dependent variables. Age and gender were the covariates. Race was the effect modifier.

RESULTS

In the overall sample, a higher level of education attainment was linked to lower odds of e-cigarette use (OR = 0.76, 95% CI =0.61-0.95). Race showed a significant interaction with educational attainment on the outcome (OR = 1.63, 95% CI =1.04-2.56), suggesting a weaker negative association between high educational attainment and e-cigarette use for Blacks than Whites. In race-stratified logistic regression models, high educational attainment was inversely associated with risk of e-cigarette use for Whites but not Blacks.

CONCLUSIONS

Educational attainment shows a stronger effect on e-cigarette use in White than Black Americans.

Being Married Increases Life Expectancy of White but Not Black Americans

Objective: The positive effect of high socioeconomic position (SEP) on health is well established. According Minorities' Diminished Returns (MDRs) theory, however, the SEP-health link is smaller for Blacks compared to Whites. Using a 25-year follow up data of a national sample, this study tested racial differences in the effects of marital status on life expectancy among American adults. Materials and methods: The data of Americans' Changing Lives (ACL, 1986 - 2011) were used. The ACL is a nationally representative longitudinal cohort study followed 3,361 White or Blacks adults from 1986 to 2011. The predictor of interest was marital status in 1986. Confounders included demographic factors (age and gender), SEP (education and employment), health behaviors (drinking, smoking, and physical activity), and health status (depressive symptoms, chronic disease, and self-rated health) all measured at baseline. Race was the moderator variable. All-cause mortality was the main dependent variable (outcome). Cox proportional hazard modeling was applied for data analysis. Results: In the overall sample, individuals who were married at baseline had a lower risk of mortality during the 25 years of follow up. Race altered the effect of marital status on life expectancy, indicating smaller protective effect for Blacks relative to Whites. Race -specific Cox regression models showed an association between marital status and life expectancy for White but not Black Americans. Conclusion: In line with the MDRs theory, the health gain that follows marital status is diminished for Black Americans compared to White Americans. Only equalizing SEP across racial groups may not be adequate for eliminating racial/ethnic health inequalities. Policies should go beyond SEP and reduce societal and structural barriers that disproportionately hinder Blacks from translating their SEP indicators to desirable health outcomes.

Unequal Effects of Educational Attainment on Workplace Exposure to Second-Hand Smoke by Race and Ethnicity; Minorities' Diminished Returns in the National Health Interview Survey (NHIS)

Background

One of the mechanisms by which high educational attainment promotes populations' health is through reducing exposure to environmental risk factors such as second-hand smoke. Minorities' Diminished Returns theory, however, posits that the protective effect of educational attainment may be smaller for racial and ethnic minority individuals particularly Blacks and Hispanics compared to Whites.

Aims

To explore racial and ethnic differences in the association between educational attainment and second-hand smoke exposure at work in a national sample of American adults.

Methods

Data came from the National Health Interview Survey (NHIS 2015), a cross-sectional study that included 15,726 employed adults. The independent variable was educational attainment, the dependent variables were any and daily second-hand smoke exposure at workplace, age and gender were covariates, and race and ethnicity were the moderators.

Results

Overall, higher educational attainment was associated with lower odds of any and daily second-hand smoke exposure at work. Race and ethnicity both interacted with educational attainment suggesting that the protective effects of educational attainment on reducing the odds of any and daily second-hand smoke exposure at work are systemically smaller for Blacks and Hispanics than Whites.

Conclusions

In the United States, race and ethnicity bound the health gains that follow educational attainment. While educational attainment helps individuals avoid environmental risk factors such as second-hand smoke, this is more valid for Whites than Blacks and Hispanics. The result is additional risk of cancer and tobacco related disease in highly educated Blacks and Hispanics. The results are important given racial and ethnic minorities are the largest growing section of the US population. We should not assume that educational attainment is similarly protective across all racial and ethnic groups. In this context, educational attainment may increase, rather than reduce, health disparities.

Educational Attainment and Exercise Frequency in American Women; Blacks' Diminished Returns

BACKGROUND

Minorities' Diminished Returns (MDRs) refer to smaller protects health effects of socioeconomic status (SES) indicators for Blacks and other minority groups than Whites.

OBJECTIVES

The current study aimed to explore Black- White differences in the association between educational attainment and exercise frequency among women in the US.

METHODS

For the current study, we used the National Survey of American Life's (NSAL) data which included 3,175 women who were either White (n = 876) or Black (n = 2,299). The independent variable was educational attainment. The dependent variable was exercise frequency. Age, region, household income, financial distress, marital status, unemployment, and depression were the covariates. Race was the focal moderator. Linear regression was applied for data analysis.

RESULTS

In the overall sample of women, high educational attainment was associated with higher exercise frequency (b = 0.07, 95% CI = 0.02-0.12). Race and educational attainment showed a significant interaction (b = -0.09, 95% CI = -0.19-0.00), suggestive of a smaller effect of education attainment on exercise frequency for Black women than White women. In race specific models, high educational attainment was associated with higher exercise frequency for White (b = 0.12, 95% CI =0.04-0.20) but not Black (b = 0.03, 95% CI = -0.03-0.08) women.

CONCLUSION

In line with the past research on MDRs, White women gain more health from their educational attainment than Black women. It is not race or class but race and class that shape the health behaviors of American women.

Depression Fully Mediates the Effect of Multimorbidity on Self-Rated Health for Economically Disadvantaged African American Men but Not Women

Background. Although chronic medical conditions (CMCs), depression, and self-rated health (SRH) are associated, their associations may depend on race, ethnicity, gender, and their intersections. In predominantly White samples, SRH is shown to better reflect the risk of mortality and multimorbidity for men than it is for women, which suggests that poor SRH among women may be caused not only by CMCs, but also by conditions like depression and social relations-a phenomenon known as "the sponge hypothesis." However, little is known about gender differences in the links between multimorbidity, depression, and SRH among African Americans (AAs). Objective. To study whether depression differently mediates the association between multimorbidity and SRH for economically disadvantaged AA men and women. Methods. This survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 AA older adults (age ≥ 55 years) were enrolled in this study, of which 266 were AA men and 474 were AA women. The independent variable was the number of CMCs. The dependent variable was SRH. Age and socioeconomic status (educational attainment and marital status) were covariates. Depression was the mediator. Gender was the moderator. Structural Equation Modeling (SEM) was used to analyze the data. Results. In the pooled sample that included both genders, depression partially mediated the effect of multimorbidity on SRH. In gender specific models, depression fully mediated the effects of multimorbidity on SRH for AA men but not AA women. For AA women but not AA men, social isolation was associated with depression. Conclusion. Gender differences exist in the role of depression as an underlying mechanism behind the effect of multimorbidity on the SRH of economically disadvantaged AA older adults. For AA men, depression may be the reason people with multimorbidity report worse SRH. For AA women, depression is only one of the many reasons individuals with multiple CMCs report poor SRH. Prevention of depression may differently influence the SRH of low-income AA men and women with multimorbidity.

Psychiatric Disorders and Alcohol Consumption Among Low-Income African Americans:Gender Differences

Background: Although cooccurrence of nonsubstance use disorders (non-SUDs) and substance use is well-established in the literature, most of what we know in this regard is derived from studies that have recruited predominantly White sample populations. As a result, there is a gap in knowledge on this link among low-income African Americans (AAs). There is also a need to understand how low-income AA men and women differ in these associations. Objective: To study whether there is an association between number of non-SUDs and amount of alcohol consumption by AA adults, and whether this association varies between AA men and women. Methods: This cross-sectional study recruited a nonrandom sample of 150 AA adults with non-SUDs (i.e., major depression, bipolar disorders, obsessive–compulsive disorder, paranoid disorder, panic disorder, posttraumatic stress disorder (PTSD), and schizoaffective disorder). The independent variable was the number of non-SUDs. The dependent variable was the amount of alcohol consumption. Age, socioeconomic status (educational attainment and household income), and self-rated health were covariates. Gender was the moderator. Linear regression models were used to analyze the data. Results: A higher number of non-SUDs was not associated with a higher amount of alcohol use in the pooled sample of AA adults. We, however, found a significant interaction between gender and number of non-SUDs on the amount of alcohol use, suggesting a stronger effect of non-SUDs on alcohol consumption in AA men than in AA women. Gender-stratified linear regression models showed a positive association between number of non-SUDs and amount of alcohol consumption in AA men but not in AA women. Conclusion: Non-SUDs impact alcohol use of AA men but not women. Future research should test whether AA men may have a higher tendency to turn to alcohol to regulate their emotions and cope with psychological pain due to multiple non-SUDs. The results also suggest that integration of services for SUDs and non-SUDs may be more relevant to provision of mental health services for AA men than AA women.

Cigarette Smoking among Economically Disadvantaged African-American Older Adults in South Los Angeles: Gender Differences

The current study aims to explore gender differences in the risk of cigarette smoking among African-American (AA) older adults who live in economically disadvantaged urban areas of southern Los Angeles. This cross-sectional study enrolled 576 older AA adults (age range between 65 and 96 years) who were residing in Service Planning Area 6 (SPA 6), one of the most economically challenged areas in southern Los Angeles. All participants had cardiometabolic disease (CMD). Data were collected using structured face-to-face interviews. Demographic factors (age and gender), socioeconomic status (educational attainment and financial difficulty), health (number of comorbid medical conditions and depressive symptoms), and health behaviors (current alcohol drinking and current smoking) were measured. Logistic regressions were used to analyze the data without and with interaction terms between gender and current drinking, depressive symptoms, and financial difficulty. AA men reported more smoking than AA women (25.3% versus 9.3%; p < 0.05). Drinking showed a stronger association with smoking for AA men than AA women. Depressive symptoms, however, showed stronger effects on smoking for AA women than AA men. Gender did not interact with financial difficulty with regard to current smoking. As AA older men and women differ in psychological and behavioral determinants of cigarette smoking, gender-specific smoking cessation interventions for AA older adults who live in economically deprived urban areas may be more successful than interventions and programs that do not consider gender differences in determinants of smoking. Gender-tailored smoking cessation programs that address drinking for AA men and depression for AA women may help reduce the burden of smoking in AA older adults in economically disadvantaged urban areas. Given the non-random sampling, there is a need for replication of these findings in future studies.

Parental Educational Attainment Differentially Boosts School Performance of American Adolescents: Minorities' Diminished Returns

Objective: To explore racial and ethnic variation in the effects of parental educational attainment on students' grade point average (GPA) in the US. As suggested by the Minorities' Diminished Returns (MDR) theory, socioeconomic status (SES) systemically results in smaller outcomes for non-Whites compared to Whites. We still know very little about diminished trans-generational returns of SES resources such as parental educational attainment. For example, the differential impacts of parental educational attainment on school performance of youth from various racial and ethnic backgrounds are still unknown. Materials and methods: The Population Assessment of Tobacco and Health (PATH 2013 - 2014) is a nationally representative survey in the US. The total sample was 10,701 youth (12-17 years old) were enrolled. The independent variable was parental educational attainment. The main outcome was GPA measured using self-report. Age, gender, and parental marital status were the covariates. Race and ethnicity were the effect modifiers. Linear regression models were used to analyze the data. Results: Overall, higher parental educational attainment was associated with a higher GPA, independent of all possible confounders. Race and ethnicity, however, both showed significant interaction with parental educational attainment on students' GPA, indicating smaller positive effects of parental educational attainment on students' GPA for Hispanic and Black compared to non-Hispanic White youth. Conclusion: The boosting effect of parental educational attainment on GPA is smaller for Black and Hispanic compared to White youth. To minimize diminished returns of parental educational attainment for Black and Hispanic families, there is a need for innovative public and social policies and programs that are not limited to equalizing SES but also address the structural barriers that disproportionately limit upward social mobility of racial and ethnic minority students and their families. The US society should reduce extra costs of upward social mobility for racial and ethnic minority families. As the underlying mechanisms are multifaceted, multi-level approach is needed to undo minorities' diminished returns, so every individual can gain the same tangible outcome from their SES resources.

High sense of mastery reduces psychological distress for African American women but not African American men

Recent research has suggested that relative to Whites, African Americans (AAs) may be at a systemic disadvantage regarding the health effects of socioeconomic position (SEP) indicators as well as psychological assets (e.g., sense of mastery). However, less is known about how these diminished returns differ between AA men and women. This study tested whether AA men and women differ in the mental health effects of high sense of mastery. The National Survey of American Life (NSAL, 2003) recruited 3570 AA adults who were either female (n = 2299) or male (n = 1271). Dependent variable was psychological distress. Independent variable was sense of mastery. Gender was the focal moderator. Age and educational attainment were the covariates. Multiple linear regression model was applied for statistical analysis. Overall, high sense of mastery was associated with lower psychological distress. Significant interaction was found between gender and sense of mastery on psychological distress suggestive of a stronger association for AA women compared to men. A smaller mental health gain of high sense of mastery for AA men compared to AA women is indicative of within race heterogeneity regarding diminished returns. Racism and discrimination may be why high sense of mastery does not translate to mental health gain for AA men.

Race, Education Attainment, and Happiness in the United States

BACKGROUND AND OBJECTIVES

As suggests by the Minorities' Diminished Returns (MDR) theory, education attainment and other socioeconomic status (SES) indicators have a smaller impact on the health and well-being of non-White than White Americans. To test whether MDR also applies to happiness, in the present study, Blacks and Whites were compared in terms of the effect of education attainment on the level of happiness among American adults.

METHODS

General Social Survey (1972-2016) is a series of national surveys that are performed in the United States. The current analysis included 54,785 adults (46,724 Whites and 8,061 Blacks). The years of schooling (i.e., education attainment) and happiness were the main independent variable and the main dependent variable of interest, respectively. In addition, other parameters such as gender, age, employment status, marital status, and the year of the survey were the covariates and race was the focal effect modifier. Finally, the logistic regression model was used to analyze the data.

RESULTS

Based on the results, high education attainment was associated with higher odds of happiness in the pooled sample. Further, a significant interaction was found between race and education attainment on the odds of happiness, showing a larger gain for Whites compared to Blacks. Race-specific models also confirmed this finding (i.e., a larger magnitude of the effect of education for Whites compared to Blacks).

CONCLUSION

Overall, the MDR theory also applies to the effect of education attainment on happiness. Blacks' disadvantage in comparison to the Whites in gaining happiness from their education may be due to the structural, institutional, and interpersonal racism and discrimination in the US. Therefore, there is a need for economic and public policies that can minimize the Blacks' diminished returns of education attainment and other SES resources.

Parental Education Attainment and Educational Upward Mobility; Role of Race and Gender

Background. The Minorities' Diminished Return theory suggests that education attainment and other socioeconomic resources have smaller effects on the health and well-being of African Americans and other racial and ethnic minorities compared to Whites. Racial and ethnic differences in the processes involved with educational upward mobility may contribute to the diminished returns of education attainment for African Americans compared to Whites. Aim: This study compared African Americans and non-Hispanic Whites for the effect of parental education attainment on educational upward mobility and explored gender differences in these effects. Methods. The National Survey of American Life (NSAL 2003) is a nationally representative survey of American adults. Participants included 891 non-Hispanic White and 3570 African American adults. Gender, race/ethnicity, age, highest parental education attainment, and respondents' educational attainment were measured. Data were analyzed using linear regression models. Results. Overall, higher parental education attainment was associated with higher educational upward mobility (b = 0.34, p < 0.001), however, this boosting effect was significantly smaller for African Americans compared to Whites (b = -0.13, p = 0.003). Our further analysis showed that race by parental education attainment can be found for females (b = -0.14, p = 0.013) but not males (p > 0.05). Conclusion. African American females are at a disadvantage compared to White females regarding the effect of parental education attainment on their educational upward mobility, a phenomenon which could not be observed when comparing African American and White males. These results advocate for taking intersectionality frameworks to study the effects of race, gender, and class in the US.