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BACKGROUND In this paper, we use the Health and Retirement Study (HRS) to examine the relationship between an estimated measure of pulse wave velocity (ePWV) and cognitive impairment with no dementia and dementia, respectively. METHODS We modeled the relationship between ePWV and cognitive status in 2006/2008 using data from 8,492 men and women (mean age 68.6 years) controlling for age, blood pressure, sociodemographic, and socioeconomic characteristics (sex, race and ethnicity, education, income, wealth), health behaviors (smoking and physical activity), body mass index (BMI), health status and related medication use (history of cardiovascular disease, diabetes, and stroke), and cerebrovascular disease (CVD)-related biomarkers (C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol, high-density lipoprotein [HDL] cholesterol). We assess cognitive function with the 27-item Langa-Weir Telephone Interview for Cognitive Status (TICS) scale. ePWV is derived from an equation based on participant age and resting blood pressure. RESULTS In a model that controlled for the constituent components of ePWV (age, age squared, systolic and diastolic blood pressure), ePWV is associated with increased odds of having cognitive impairment with no dementia (OR = 2.761) and dementia (OR = 6.344) relative to a group with no cognitive impairment or dementia. After controlling for the constituent components of ePWV, sociodemographic and socioeconomic characteristics, health behaviors, BMI, health status and medication use, and CVD-related biomarkers, ePWV remains significantly associated with dementia (OR = 3.969) but not cognitive impairment with no dementia (OR = 1.782). CONCLUSIONS These findings suggest that ePWV may be a novel research tool and biomarker of vascular aging that can be used in large, population-representative studies to examine cognitive aging and dementia risk. [ABSTRACT FROM AUTHOR]

Population health research finds women's mortality risk associated with childlessness, low parity (one child), and high parity (6+ children) in a U-shaped pattern, although U.S. studies are inconsistent overall and by race/ethnicity. Parity, however, is contingent on women's biophysiological likelihood of (in)fecundity as well as voluntary control practices that limit fertility. No studies have empirically examined infecundity differentials among women and their potential contribution to the parity–post-reproductive mortality relationship or the race/ethnic-related mortality gap. We examine 7,322 non-Hispanic Black and White women, born 1920–1941, in the Health and Retirement Study, using zero-inflation methods to estimate infecundity risk and parity by race/ethnicity. We estimate proportional hazards models [t0 1992/1998, t1 2018] to examine associations of infecundity risk, parity, early-life-course health and social statuses, and post-reproductive statuses with all-cause mortality. We find Black women's infecundity probability to be twice that of White women and their expected parity 40% higher. Infecundity risk increases mortality risk for all women, but parity–post-reproductive mortality associations differ by race/ethnicity. White women with one and 5+ children (U-shaped curve) have increased mortality risk, adjusting for infecundity risk and early-life factors; further adjustment for post-reproductive health and social status attenuates all parity-related mortality risk. Black women's parity–post-reproductive mortality associations are not statistically significant. Black women's post-reproductive mortality risk is anchored in earlier-life conditions that elevate infecundity risk. Results suggest a need to focus upstream to better elucidate race/ethnic-related social determinants of reproductive health, infecundity, parity, and mortality. [ABSTRACT FROM AUTHOR]

As this issue of the "Future of Children" makes clear, there is much yet to learn about military children and their families. A big part of the reason, write Anita Chandra and Andrew London, is the lack of sufficiently robust sources of data. Until more and better data are collected about military families, Chandra and London say, it will be difficult to study the breadth of their experiences and sources of resilience, distinguish among subgroups within the diverse military community, or compare military children with their civilian counterparts. After surveying the available sources of data and explaining what they are lacking and why, Chandra and London make several recommendations. First, they say, major longitudinal national surveys, as well as administrative data systems (for example, in health care and in schools), should routinely ask about children's connections to the military, so that military families can be flagged in statistical analyses. Second, questions on national surveys and psychological assessments should be formulated and calibrated for military children to be certain that they resonate with military culture. Third, researchers who study military children should consider adopting a life-course perspective, examining children from birth to adulthood as they and their families move through the transitions of military life and into or out of the civilian world.

Variable military service-related experiences, such as combat exposure, psychiatric disorders (PD), and traumatic brain injuries (TBI), may differentially affect the likelihood of having health care professional-identified high blood pressure (i.e., hypertension). PURPOSE: Compare the odds of self-reported hypertension among non-combat and combat veterans with and without PD/TBI to non-veterans and each other. METHODS: We used data from men from the 2011 Behavioral Risk Factor Surveillance System and distinguished: non-veterans (n = 21,076); non-combat veterans with no PD/TBI (n = 3,150); combat veterans with no PD/TBI (n = 1,979); and veterans (combat and non-combat) with PD and/or TBI (n = 805). Multivariable, hierarchical logistic regression models included exogenous demographic, socioeconomic attainment and family structure, health behavior and conditions, and methodological control variables. RESULTS: One-third of men reported having been told at least once by a medical professional that they had high blood pressure. Bivariate analyses indicated that each veteran group had a higher prevalence of self-reported hypertension than non-veterans (design-based F = 45.2, p<0.001). In the fully adjusted model, no statistically significant differences in the odds of self-reported hypertension were observed between non-veterans and: non-combat veterans without PD/TBI (odds ratio [OR] = 0.92); combat veterans without PD/TBI (OR = 0.87); veterans with PD and/or TBI (OR = 1.35). However, veterans with PD and/or TBI had greater odds of reporting hypertension than both combat and non-combat veterans without PD/TBI (p<0.05). DISCUSSION: Military service-related experiences were differentially associated with a survey-based measure of hypertension. Specifically, veterans self-reporting PD and/or TBI had significantly higher odds of self-reporting hypertension (i.e., medical provider-identified high blood pressure). [ABSTRACT FROM AUTHOR]

We used data from the Fragile Families and Child Wellbeing Study (N = 2,679 ) to examine the impact of men's past military service on the likelihood that a couple will marry within 5 years of a nonmarital birth. Logistic regression analyses showed that men's past military service increased marriage odds by 54% for couples with Black fathers even after controlling for potential mediators. But veteran status had no effect on couples with White or Hispanic fathers. As a result, the large Black-White gap in postbirth marriage evident among couples with civilian fathers did not exist among couples with veteran fathers. Our findings bolster other evidence that military service exerts lasting and unique pro-marriage effects on Blacks.

The authors use data from the 1992 National Health and Social Life Survey to examine the association between incarceration and living arrangements, net of a range of sociodemographic and early life characteristics. Relative to living with a spouse and child(ren), there is evidence that a history of incarceration is strongly associated with several nonnuclear living arrangements, including living alone, as a sole adult with child(ren), with a partner and child(ren), with a partner but no child, and with other family but no spouse, partner, or child. These living arrangements may be indicative of lower levels of social integration, which have potentially serious consequences for these individuals as well as their families and communities. The authors discuss these results with reference to the decades-long, unprecedented mass incarceration that is ongoing in the United States today. (Contains 2 tables and 5 notes.)

Background: Carotid-femoral pulse wave velocity (cfPWV), the referent measure of aortic stiffness, is an established measure of vascular aging. In studies where cfPWV cannot be measured, alternative methods are needed to help promote research on vascular aging. This study examines the construct validity of a measure of PWV estimated from age and blood pressure (ePWV). The specific aims of the study are to: 1) explore the strength of association between ePWV, cfPWV, and other established measures of vascular aging; 2) examine the sensitivity and specificity of elevated ePWV (≥10m/s) in relation to elevated cfPWV (≥10m/s). Methods: We measured cfPWV in two-hundred and fifty-two adults (mean age 57±12 years, 48% female) and calculated each participant's ePWV from their age and brachial blood pressure. Additional measures of vascular aging included: carotid intima-media thickness (cIMT); carotid stiffness measured as elastic modulus (cEp); and carotid augmentation index (cAIx). Results: The correlations between cfPWV and measures of vascular aging were: cEp (r = 0.36), cIMT (r = 0.49), and cAIx (r = 0.04). The correlations between ePWV and measures of vascular aging were: cEp (r = 0.45), cIMT (r = 0.60), and cAIx (r = 0.24). The correlation between ePWV and cfPWV was (r = 0.67). The sensitivity and specificity of elevated ePWV (≥ 10 m/s) for concomitantly identifying high cfPWV (≥ 10 m/s) were 85.4% and 73.0% respectively. Conclusion: ePWV is associated with established measures of vascular aging, such as carotid thickness, carotid stiffness and carotid augmentation index. ePWV may be a useful tool to help promote research on vascular aging. [ABSTRACT FROM AUTHOR]

Military suicide prevention efforts would benefit from population-based research documenting patterns in risk factors among service members who die from suicide. We use latent class analysis to analyze patterns in identified risk factors among the population of 2660 active-duty military service members that the Department of Defense Suicide Event Report (DoDSER) system indicates died by suicide between 2008 and 2017. The largest of five empirically derived latent classes was primarily characterized by the dissolution of an intimate relationship in the past year. Relationship dissolution was common in the other four latent classes, but those classes were also characterized by job, administrative, or legal problems, or mental health factors. Distinct demographic and military-status differences were apparent across the latent classes. Results point to the need to increase awareness among mental health service providers and others that suicide among military service members often involves a constellation of potentially interrelated risk factors. [ABSTRACT FROM AUTHOR]

Background and Objectives The gold standard method for the assessment of vascular aging is carotid–femoral pulse wave velocity (cfPWV). cfPWV can be estimated from 2 commonly assessed clinical variables—age and blood pressure. This analysis uses data from the Health and Retirement Study to examine the relationship between estimated pulse wave velocity (ePWV) and mortality among 9,293 middle age and older adults. Research Design and Methods Cox proportional hazard models were used to predict mortality occurring over a 10- to 12-year period. Controls were included for sociodemographic characteristics (age, gender, race, ethnicity, wealth, income, and education), health status (history of cardiovascular disease [CVD], diabetes, and stroke and related medication use), health behaviors (smoking, physical activity, and body mass index), and CVD-related biomarkers (systolic and diastolic blood pressure, C-reactive protein, cystatin c, hemoglobin A1c, total cholesterol, and high-density lipoprotein cholesterol). Results By 2018, 26.19% of the weighted analytic sample were reported as deceased. In the fully specified models that control for age, age-squared, systolic and diastolic blood pressure, sociodemographic variables, health status and behaviors, and biomarkers, ePWV was associated with a greater likelihood of mortality. Discussion and Implications An estimate of PWV derived from age and blood pressure is independently associated with an increased likelihood of death in a representative sample of middle age and older adults in the United States. [ABSTRACT FROM AUTHOR]

Objectives. This study examines differences in the relationship between veteran status and men's trajectories of health conditions, activities of daily living limitations, and self-rated health. Methods. We use data on 12,631 men drawn from the 1992-2006 waves of the Health and Retirement Study to estimate growth curve models that examine differences in health trajectories between nonveterans and veterans, veterans with and without wartime service, and war service veterans who served during World War II, Korea, Vietnam, and multiple wars. Results. The results indicate that veterans have better health at the mean age of 66.2 years, but experience greater age-related changes in health than nonveterans. Similarly, men who served during wartime have better health at the mean age, but more age-related changes in health than men who did not serve during wartime. Among war veterans, Vietnam veterans are in poorer health at the mean age, but they experience less substantial age-related health changes than men who served during previous wars. Discussion. Although veterans experience better health relative to nonveterans around retirement age, they have poorer health than nonveterans among the oldest old. These findings inform our understanding of the veteran-nonveteran health-mortality paradox found in previous research and suggest a health crossover among veterans and nonveterans in later life. Key Words: Growth curve models--Health--Military service--Veterans. doi: 10.1093/geronb/gbq072.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1475-682X.2007.00210.x Byline: Ellen K. Scott (1), Andrew S. London (2), Glenda Gross (2) Abstract: Welfare reformers sought to reduce 'dependency,' or reliance on state-supported cash benefits and deployed a discourse of 'self-sufficiency' to promote the legitimacy of efforts to remove welfare recipients from publicly funded cash assistance through either wage labor or marriage. We use longitudinal, qualitative interview data collected from 38 initially welfare-reliant women to examine what self-sufficiency means to them and their perspectives on how work and marriage affect their ability to be self-sufficient. Grounded theory analysis revealed that for these women, self-sufficiency means formal independence from both the state (i.e., Temporary Assistance to Needy Families [TANF]) and men (i.e., marriage). Although they value marriage as an institution and would ideally marry, they do not consider marriage to be a likely route to self-sufficiency given the pool of men available to them. Rather, they embrace their own market-based wage labor as the means by which they can attain some measure of independence. Taking our lead from the women in this study, we challenge the emphasis on marriage in current welfare policy. We argue that employment training that results in better jobs for women and men and work supports that make low-wage work pay are clearly the appropriate direction for policy aimed at the welfare-reliant and working poor. Author Affiliation: (1)University of Oregon (2)Syracuse University

Researchers have made significant efforts to combine quantitative and qualitative methods in welfare reform policy research in the United States. This paper draws on several examples arising from the American experience to argue that mixed-methods research (particularly, but not exclusively, with integrated sampling, data collection, and data analysis) can yield important and unexpected insights that neither method alone could generate. We caution that each method has strengths and weaknesses that must be borne in mind so as not to oversell the promise of mixed-methods research. Key words--poverty, welfare reform, mixed-methods research, policy evaluation, United States

Significant racial disparities in health outcomes have been consistently documented in the United States. Life-course and population-health models are often used to explain these disparities, but they generally do not take incarceration effects into account. Incarceration may have direct effects on health, but it is more likely to indirectly affect health by shaping employment, income, and marital trajectories. The authors contend that the failure of health researchers to take incarceration effects into account is problematic given the large increase in the incarceration of Black men over the past few decades. Moreover, because large numbers of incarcerated Black men are not present in research samples, racial disparities in health outcomes may be underestimated. Incarceration effects should be included in life-course and population-health models, study designs, and policy development processes. Keywords: prison; race; health; life course

The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) encouraged states to reduce welfare caseloads. Caseload reduction can be accomplished by promoting exit for work, marriage, or other private means of support and by diverting new applicants. Most research on caseload decline has focused on welfare-to-work outcomes; less is known about processes of diversion. This study employs administrative records and ethnographic data to examine diversion in West County, New York, from 1999 to 2003. Findings demonstrate a high level of diversion and suggest that application is an ongoing and at times remedial process rather than an event. Diversion occurs at all points of the expanded TANF (Temporary Assistance to Needy Families) intake process and is associated with onetime lump sum payments as well as the hassle factor engendered by new eligibility requirements. The encumbered lives of applicants and TANF staff discretion are also implicated as factors contributing to diversion. We conclude with an analysis of the implications of TANF diversion for access to benefits., Introduction In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA; PL104-193) replaced Aid to Families with Dependent Children (AFDC) with Temporary Assistance to Needy Families (TANF). By 'changing [...]

This study uses a life-course framework and data from the Health and Retirement Study and the Study of Assets and Health Dynamics Among the Oldest-Old to examine three hypotheses related to (dis)continuity in the effects of early-life disadvantage (African American race and low paternal education) and military service on later-life mortality. Specifically, the authors consider whether military service (and age at enlistment) mediates or moderates the effects of early-life disadvantage on later-life mortality and whether mid- to late-life marital status, socioeconomic status, health status, and health behaviors mediate the effects of military service on mortality. The authors find very little evidence to support the notion that any mortality benefits accrue to men as a consequence of military service overall or enlistment at any particular age. Most of the evidence is consistent with life-course disruption and continuity of disadvantage interpretations. Keywords: military service; mortality; life course; cumulative disadvantage

Objectives. This study examined the influence of sociodemographic, clinical, and attitudinal variables on the use of alternative therapists by people in care for HIV. Methods. Bivariate and multivariate analyses of baseline data from the nationally representative HIV Cost and Services Utilization Study were conducted. Results. Overall, 15.4% had used an alternative therapist, and among users, 53.9% had fewer than 5 visits in the past 6 months. Use was higher for people who were gay/ lesbian, had incomes above $40000, lived in the Northeast and West, were depressed, and wanted more information about and more decisionmaking involvement in their care. Among users, number of visits was associated with age, education, sexual orientation, insurance status, and CD4 count. Conclusions. Among people receiving medical care for HIV, use of complementary care provided by alternative therapists is associated with several sociodemographic, clinical, and attitudinal variables. Evaluation of the coordination of provider-based alternative and standard medical care is needed.

Objective: To establish population-based estimates of the prevalence of any alcohol consumption and heavy drinking among individuals who tested positive for human immunodeficiency virus (HIV) and to identify the factors associated with alcohol consumption and heavy drinking in this population. Method: Data from the HIV Cost and Services Utilization Study (HCSUS), a national probability survey of HIV-infected adults receiving medical care in the U.S. in early 1996 (N = 2,864; 2,017 men, 847 women), were used to estimate the prevalence of any alcohol consumption and heavy drinking. Logistic regression was used to identify independent influences of soeiodemographic, health status, and substance use variables on alcohol consumption and heavy drinking. Results: Approximately 53% of persons in care for HIV reported drinking alcohol in the preceding month and 8% were classified as heavy drinkers. Of those who drank, 15% were heavy drinkers. The odds of heavy drinking were significantly higher among users of cocaine or heroin and significantly lower among the better educated and those with an AIDS-defining illness. Conclusions: Alcohol consumption is common among people in care for HIV, with rates of heavy drinking almost twice those found in the general population. Heavy drinking is especially higher among individuals with lower educational levels and users of cocaine or heroin. (J. Stud. Alcohol 63: 179-186, 2002), CONSIDERABLE EVIDENCE INDICATES that heavy alcohol consumption is deleterious to the health and well-being of persons living with the human immunodeficiency virus (HIV). Heavy alcohol use intensifies the effect of [...]

Young Men who have Sex with Men (MSM) continue to face disproportionate HIV risk. Despite its well accepted role in HIV prevention, pre-exposure prophylaxis (PrEP) uptake remains below desired goals. Systemic barriers to PrEP access, including insurance complexity, cost, and wait times to start PrEP may contribute to low PrEP engagement. We conducted in-depth interviews and designed a discrete choice experiment (DCE) to assess preferences for and barriers to PrEP access in the United States. Methods: We conducted in-depth interviews with 18 MSM aged 18–30 years old who were not on PrEP and created a DCE based on the results. For the DCE, a convenience sample of young MSM in the United States who reported recent condomless anal sex was recruited through social media applications. Consenting participants provided sociodemographic information and responded to a series of 10 choice tasks about PrEP access. Preferences were analyzed utilizing marginal willingness-to-pay (mWTP) methods. Results: In-depth interviews revealed preferences for highly effective PrEP and concerns about barriers to access due to insurance coverage and privacy. The online DCE was completed by 236 eligible MSM aged 18–30. The most-preferred PrEP package—with all elements significantly preferred over other options—was insurance covered, could be maintained confidential from parents and employers, was available immediately, and had an online option. Need to take out new insurance or add a supplemental insurance in order to cover PrEP significantly detracted from willingness to pay for a PrEP program. Attributes most associated with willingness to pay for PrEP were PrEP being covered by an insurance the client already has and insurance coverage that was private. Conclusions: Young MSM at high risk for HIV in the United States who are not currently on PrEP showed strong preferences for PrEP options that were covered by insurance and could be kept confidential from parents and employers. Lack of these options may present major barriers to PrEP access among young MSM who are at particularly high risk. Rapid access to PrEP, as well as the option of receiving some care online, may also enhance PrEP uptake. [ABSTRACT FROM AUTHOR]

We draw upon the life-course perspective and examine whether Attention Deficit Hyperactivity Disorder (ADHD) moderates the age pattern of adult mortality using data from the 2007 and 2012 National Health Interview Survey Sample Adult File linked to National Death Index data through 2015. Overall, 7.0% of respondents died by 2015. Discrete-time hazard analysis indicates that the log odds of mortality were significantly lower among 18 and 19 year old adults ever diagnosed with ADHD and significantly higher among 46 to 64 year old adults ever diagnosed with ADHD, with a crossover occurring at age 33. Results were similar among men and women. It is not known specifically which risks drive changes in the risk of mortality documented among persons with ADHD during the transition to adulthood, the increased risk of mortality in midlife, or whether some risks operate more or less at particular ages. Additional research can lead to targeted, age- and life-course stage-focused interventions for specific risks and contribute to the reduction of ADHD-related mortality. [ABSTRACT FROM AUTHOR]

Informal care has become an increasingly important element in the delivery of health and social services to people living with HIV disease or AIDS (PWAs), yet the provision of such care does not come without costs to the caregiver. Instead, caregiving imposes burdens that may compromise caregiver health. Common ailments among AIDS caregivers were examined with two waves of data from a diverse sample of informal care providers in Los Angeles and San Francisco (N = 642). Symptoms of poor physical health are markedly present among AIDS caregivers and are significantly associated with care-related demands and stressors. This stress and health relationship varies significantly between caregivers who are HIV seropositive and those who are seronegative. Care-related effects are more direct among seronegative caregivers who are perhaps less overwhelmed with the maintenance of their own health. For all caregivers studied, level of depression and prior physical health are strong correlates of these physical ailments. Implications of these results are discussed. Key words - AIDS, caregiving, stress, health

Research increasingly considers how collective narratives/experiences of HIV influence understandings of and responses to COVID-19 among men who have sex with men and how these discussions articulate with the larger literature on the social significance of epidemics. Drawing on interviews with 30 men who have sex with men, as well as discussion of epidemics as dramaturgical events, this study aimed to determine how men living in the USA make sense of COVID-19 in the light of their collective knowledge and/or memories of the HIV pandemic. Participants experienced progressive revelations regarding COVID-19's seriousness and constructed frameworks with which to manage the unpredictability of infection. Participants also believed that the initial public response to COVID-19 on the part of the US federal government, health officials and the scientific community, although inadequate, was stronger and more extensive than the response had been to HIV. As communities and the USA negotiated their pandemic responses, participants negotiated their own personal responses with incomplete, uncertain, dynamic and conflicting information. This study provides evidence regarding the social organisation of a contemporary pandemic and how individuals perceive and guard against risk, assign responsibility for virus transmission and acquisition, and navigate the threat of a potentially deadly infection. [ABSTRACT FROM AUTHOR]

This research examines concentration and similarity in the first name distributions of African Americans and whites resident in Mississippi in 1910. Data are drawn from the Public Use Sample of the 1910 Census, with names added from microfilm copies of original Census manuscripts. We find little difference in the degree of concentration of the name distributions and only modest dissimilarity in name choice. Multivariate analysis using age as a proxy for period of name assignment (birth cohort) indicates that racial differentiation in name choice increased over the period 1870 to 1910 primarily as a result of changes in the name choices of whites. We discuss these results in conjunction with the recent work of Lieberson and Bell (1992) on contemporary racial differences in naming patterns. Lieberson and Bell (1992) argue that African Americans in the contemporary period emphasize group differences by choosing 'African' or 'African sounding' names. In Mississippi in the period between the abolition of slavery and 1910, we argue that whites distanced themselves from African Americans by choosing increasingly the 'whitest' names (e.g., those disproportionately chosen by whites). Changing naming patterns are not orchestrated group responses. Instead, they reflect emergent cultural responses to fundamental social change.