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Background: The annual incidence of sudden cardiac death is over 300,000 in the United States (US). Historically, inpatient implantation of secondary prevention implantable cardioverter defibrillator (ICD) has been variable and subject to healthcare disparities. Objective: To evaluate contemporary practice trends of inpatient secondary prevention ICD implants within the US on the basis of race, sex, and socioeconomic status (SES). Methods: The study is a retrospective analysis of the National Inpatient Sample from 2016 to 2020 of adult discharges with a primary diagnosis of ventricular tachycardia (VT), ventricular flutter, and fibrillation (VF). Adjusted ICD implantation rates based on race, sex, and SES and associated temporal trends were calculated using multivariate regression. Results: A total of 193,600 primary VT/VF discharges in the NIS were included in the cohort, of which 57,895 (29.9%) had ICD placement. There was a significant racial and ethnic disparity in ICD placement for Black, Hispanic, Asian, and Native American patients as compared to White patients; adjusted odds ratio (aOR): 0.86 [p <.01], 0.90 [p =.03], 0.81[p <.01], 0.45 [p <.01], respectively. Female patients were also less likely to receive an ICD compared to male patients (aOR: 0.75, p <.01). Disparities in ICD placement remained stable over the study period (ptrend ≥.05 in all races, both sexes and income categories). Conclusion: Racial, sex, and SES disparities persisted for secondary prevention ICD implants in the US. An investigation into contributing factors and subsequent approaches are needed to address the modifiable causes of disparities in ICD implantation as these trends have not improved compared to historic data. [ABSTRACT FROM AUTHOR]

Purpose: United States (US) Latinos have the lowest educational attainment of any US racial/ethnic group, which may contribute to their disparate burden of Type 2 Diabetes. Herein, we aimed to examine the association between intergenerational educational mobility and Type 2 Diabetes among US Latino adults.Methods: We used data from the Niños Lifestyle and Diabetes Study (2013-2014) and the Sacramento Area Latino Study on Aging (1998-1999) to link 616 adult Latino children to their parents. Model-based standardization and robust Poisson regression were used to estimate the prevalence of prediabetes, Type 2 Diabetes, treatment and glycemic control, and describe their associations with intergenerational educational mobility.Results: Adult children with stable high intergenerational educational attainment had a higher prevalence of prediabetes (Prevalence Ratio, PR=1.58; 95% Confidence Interval, CI=1.08, 2.34) and lower prevalence of Type 2 Diabetes (PR=0.64, CI=0.41, 0.99), as compared to those who experienced low educational attainment across generations. Downward mobility was associated with a higher prevalence of prediabetes (PR=1.54, CI=1.06, 2.23) and worse glycemic control (PR=2.20, CI=1.13, 4.30), and upward mobility was associated with a lower prevalence of Type 2 Diabetes (PR=0.39, CI=0.22, 0.70).Conclusions: Our findings from a predominantly Mexican-heritage community suggest that higher education across generations may buffer individuals from glycemic dysregulation. As such, higher education may be a promising public health target to address the rising burden of Type 2 Diabetes in the US. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of alcohol use disorder (AUD) in primary care is critical for increasing access to alcohol treatment. However, AUD is underdiagnosed and may be inequitably diagnosed due to societal structures that determine access to resources (e.g., structural racism that limits opportunities for some groups and influences interpersonal interactions in and beyond health care). This study described patterns of provider-documented AUD in primary care across intersections of race, ethnicity, sex, and community-level socioeconomic status (SES)., Methods: This cross-sectional study used EHR data from a regional healthcare system with 35 primary care clinics that included adult patients who completed alcohol screenings between 3/1/2015 and 9/30/2020. The prevalence of provider-documented AUD in primary care based on International Classification of Diseases-9 (ICD-9) and ICD-10 diagnoses was compared across intersections of race, ethnicity, sex, and community-level SES., Results: Among 439,375 patients, 6.6% were Latine, 11.0% Asian, 5.4% Black, 1.3% Native Hawaiian/Pacific Islander (NH/PI), 1.5% American Indian/Alaska Native (AI/AN), and 74.2% White, and 58.3% women. The overall prevalence of provider-documented AUD was 1.0% and varied across intersecting identities. Among women, the prevalence was highest for AI/AN women with middle SES, 1.5% (95% CI 1.0-2.3), and lowest for Asian women with middle SES, 0.1% (95% CI 0.1-0.2). Among men, the prevalence was highest for AI/AN men with high and middle SES, 2.0% (95% CI 1.1-3.4) and 2.0% (95% CI 1.2-3.2), respectively, and lowest for Asian men with high SES, 0.5% (95% CI 0.3-0.7). Black and Latine patients tended to have a lower prevalence of AUD than White patients, across all intersections of sex and SES except for Black women with high SES. There were no consistent patterns of the prevalence of AUD diagnosis that emerged across SES., Conclusion: The prevalence of provider-documented AUD in primary care was highest in AI/AN men and women and lowest in Asian men and women. Findings of lower prevalence of provider-documented AUD in Black and Hispanic than White patients across most intersections of sex and SES differed from prior studies. Findings may suggest that differences in access to resources, which vary in effects across these identity characteristics and lived experiences, influence the diagnosis of AUD in clinical care., (© 2024. The Author(s).)

Background: Few national studies across the United States' rural-urban continuum examine neighborhood effects on snacks and sweets intake among adults., Objectives: This study examines associations of urbanicity/rurality-tailored measures of food store availability and neighborhood socioeconomic status (NSES) with the intake of snacks and sweets in a national sample of middle and older age adults., Methods: This cross-sectional study used food frequency questionnaire data collected in the REasons for Geographic And Racial Differences in Stroke study (N = 21,204). What We Eat in America food group categorizations guided outcome classification into 1 main category (total snacks and sweets) and 4 subcategories (savory snacks and crackers; sweet bakery products; candy and desserts; nutrition bars and low-fat snacks and sweets). NSES and food store availability were determined using geographic information systems. Food store availability was characterized as geographic access to primary food stores (e.g., supermarkets, supercenters, and select food retailers) in urbanicity/rurality-tailored neighborhood-based buffers. Multiple linear regression was used to predict each outcome., Results: Living in neighborhoods with a high density of primary food stores was associated with 8.6%, 9.5%, and 5.8% lower intake of total snacks and sweets, sweet bakery products, and candy and desserts, respectively. Living in the highest NSES quartile was associated with 11.3%, 5.8%, and 18.9% lower intake of total snacks and sweets, savory snacks and crackers, and sweet bakery products, respectively. Depending on primary food store availability, higher household income was associated with significantly greater intake of nutrition bars and low-fat snacks and sweets. Living in a United States Department of Agriculture-defined food desert was not associated with intake., Conclusions: In a geographically diverse sample of middle and older age United States adults, living in neighborhoods with no primary food stores or neighborhoods of low-SES was associated with higher intake of total snacks and sweets and subgroups of snacks and sweets., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background: Although many studies demonstrated reduced mortality risk with higher greenness, few studies examined the modifying effect of greenness on air pollution-health associations. We evaluated residential greenness as an effect modifier of the association between long-term exposure to fine particles (PM2.5) and mortality.Methods: We used data from all Medicare beneficiaries in North Carolina (NC) and Michigan (MI) (2001-2016). We estimated annual PM2.5 averages using ensemble prediction models. We estimated mortality risk per 1 μg/m3 increase using Cox proportional hazards modeling, controlling for demographics, Medicaid eligibility, and area-level covariates. We investigated health disparities by greenness using the Normalized Difference Vegetation Index with measures of urbanicity and socioeconomic status.Results: PM2.5 was positively associated with mortality risk. Hazard ratios (HRs) were 1.12 (95% confidence interval (CI) = 1.12 to 1.13) for NC and 1.01 (95% CI = 1.00 to 1.01) for MI. HRs were higher for rural than urban areas. Within each category of urbanicity, HRs were generally higher in less green areas. For combined disparities, HRs were higher in low greenness or low SES areas, regardless of the other factor. HRs were lowest in high-greenness and high-SES areas for both states.Conclusions: In our study, those in low SES and high-greenness areas had lower associations between PM2.5 and mortality than those in low SES and low greenness areas. Multiple aspects of disparity factors and their interactions may affect health disparities from air pollution exposures. Findings should be considered in light of uncertainties, such as our use of modeled PM2.5 data, and warrant further investigation. [ABSTRACT FROM AUTHOR]

Many parents continue to parent their emerging-adult children, but what becomes developmentally appropriate for such children differs from that of earlier ages. In addition, culture and context shape parenting and in turn child outcomes. Among an adolescent sample, higher-SES youth engage in higher levels of risk behaviors to manage the pressures they face from trying to live up to their parents' high expectations for achievement compared to low- and middle-SES youth. Researchers have not yet examined the role of SES on emerging adults' likelihood of engaging in risk behaviors in response to controlling parenting. Therefore, the current study explored the role of SES on the associations among emerging adults' perceptions of their parents' parenting behaviors (i.e., behavioral control, psychological control, and helicopter parenting) and change in their own risk behaviors. Undergraduate students (N = 551; Mage = 19.87, SD = 2.00; 60.6% women; 61% European American; 28.6% higher-SES) from four universities throughout the U.S. completed both waves of the study. Participants completed scales on each of their parents' behavioral control, psychological control, and helicopter parenting, as well as a self-report measure of their own engagement in risk behaviors. Results indicated that maternal and paternal psychological control were associated positively with change in risk behaviors. Additionally, maternal and paternal behavioral control were associated with greater change in risk behaviors for higher-SES, but not lower-SES emerging adults. The findings provide new insights into the role of SES on the differential influence of parental behavioral control, psychological control, and helicopter parenting on change in emerging adults' risk behaviors. [ABSTRACT FROM AUTHOR]

While low socioeconomic status (SES) introduces risk for developmental outcomes among children, there are an array of proximal processes that determine the ecologies and thus the lived experiences of children. This study examined interrelations between 22 proximal measures in the economic, psychosocial, physiological, and perinatal ecologies of children, in association with brain structure and cognitive performance in a diverse sample of 8,158 9–10-year-old children from the Adolescent Brain Cognitive Development (ABCD) study. SES was measured by the income-to-needs ratio (INR), a measure used by federal poverty guidelines. Within the ABCD study, in what is one of the largest and most diverse cohorts of children studied in the United States, we replicate associations of low SES with lower total cortical surface area and worse cognitive performance. Associations between low SES (<200% INR) and measures of development showed the steepest increases with INR, with apparent increases still visible beyond the level of economic disadvantage in the range of 200–400% INR. Notably, we found three latent factors encompassing positive ecologies for children across the areas of economic, psychosocial, physiological, and perinatal well-being in association with better cognitive performance and the higher total cortical surface area beyond the effects of SES. Specifically, latent factors encompassing youth perceived social support and perinatal well-being were positive predictors of developmental measures for all children, regardless of SES. Further, we found a general latent factor that explained relationships between 20 of the proximal measures and encompassed a joint ecology of higher social and economic resources relative to low adversity across psychosocial, physiological, and perinatal domains. The association between the resource-to-adversity latent factor and cognitive performance was moderated by SES, such that for children in higher SES households, cognitive performance progressively increased with these latent factor scores, while for lower SES, cognitive performance increased only among children with the highest latent factor scores. Our findings suggest that both positive ecologies of increased access to resources and lower adversity are mutually critical for promoting better cognitive development in children from low SES households. Our findings inform future studies aiming to examine positive factors that influence healthier development in children. [ABSTRACT FROM AUTHOR]

BACKGROUND: Women of parenting age from typically marginalized socioeconomic, ethnic, and racial groups are underrepresented in rehabilitation research. The literature indicates that women with disabilities and low socioeconomic status have poor outcomes related to employment and independent living. METHODS: The current study was a secondary data analysis of 8,350 women receiving TANF who completed vocational rehabilitation services from the RSA 911 dataset from fiscal years 2015 and 2016. To meet study aims, descriptive statistics were used to calculate frequencies, means, and percentages for each study variable. A multivariate logistic regression analysis identified demographic variables and vocational rehabilitation services as predictors of employment. RESULTS: Study findings indicated that on the job training, job search assistance/job placement assistance, short term job supports, and maintenance services were significant predictors of employment among the sample. Demographic predictors of employment are also reported. CONCLUSION: Findings indicate having a high school education or GED predicts positive employment outcomes for women receiving TANF. Provision of services related to the area of maintenance services, including support for food, clothing, and shelter are important features to address in vocational rehabilitation when supporting successful vocational outcomes for women with children and low socioeconomic status. [ABSTRACT FROM AUTHOR]

This study assesses trends and differentials in happiness among the U.S. population. Using data from the General Social Survey, 1972–2016 and the intersectionality paradigm to guide this work, I find that happiness differentials across gender and race are generally converging; however, patterns are quite complex and contingent on group membership (i.e. gender, race). Black women for instance, present a consistent pattern of improvement in happiness across decades, while White women display a persistent pattern of decline. In contrast, Black men experienced a discernable pattern of improvement in happiness between the 1970s and 1990s, followed by a leveling off in the early-2000s. White men experienced moderate gains in happiness between the 1970s and 1990s, but after the Great Recession/Obama Era, White male happiness followed a pattern of unprecedented decline, with the "happiness advantage" they once enjoyed (as a group) over Black men and women largely vanishing. In fact, although advantaged White men in the general population (i.e. financially satisfied) were about as happy as their White female and African–American female peers after the Great Recession, disadvantaged White men who were financially dissatisfied were less likely to report the same sentiment when compared to their White female and Black female peers who were similarly disadvantaged. Taking these patterns in account, I conclude with a discussion of what these patterns demonstrate regarding the changing nature of racial and gender inequality in the United States, past and present. [ABSTRACT FROM AUTHOR]

Social class has many meanings and components – economic, social, political, one's sense of identity, and how class intersects with other social identities – so it is difficult to define it briefly and succinctly. These definitions are further complicated by a global lens, where family of origin, geography, and other factors can pre-determine social class. In this article, we explore the complexities and contradictions of social class in the context of the United States as we believe that this is important for social work, particularly in the age of Donald Trump, where class, and its intersection with race and immigration status, is often used as a weapon to divide society and seek political advantages. While such use of class categories is not new in this country or in political rhetoric globally, the current climate in the United States warrants a review. [ABSTRACT FROM AUTHOR]

Abstract Rationale Food insecurity is a significant social problem that has been found to co-occur with both poverty and depression. However, few studies have utilized longitudinal data to investigate the associations among poverty, depression, and food insecurity. Objective This study tested two competing hypotheses, the food inadequacy hypothesis and the mental health hypothesis, in examining the associations among family socioeconomic status (SES), maternal depression, and household food insecurity across children's first five years of life. Methods Data were drawn from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a dataset nationally representative of all children born in the United States in 2001. Mothers reported family SES and household food insecurity when their children were nine months, 24 months, four years, and at kindergarten entry; maternal self-rated depressive symptoms were included at nine months, four years, and kindergarten entry. Results An autoregressive cross-lagged model showed that family SES was predictive of later household food insecurity, which in turn was associated with later maternal depressive symptoms. Significant mediation pathways were found with household food insecurity mediating the link between family SES and maternal depressive symptoms. Conclusions This study highlights the need to consider household food insecurity as an underlying mechanism of maternal depressive symptoms in under-resourced families. Findings of this study can inform public health policy by highlighting the importance of considering factors such as food insecurity in the delivery of services to depressed mothers and their children in under-resourced contexts, and emphasizing the need for coordinated, integrated care in responding to the needs of these high-risk, vulnerable families. Highlights • Socioeconomic status (SES), maternal depression, and food insecurity were examined. • The longitudinal direction among these variables was tested across five years. • Food insecurity was a mediator between family SES and maternal depressive symptoms. [ABSTRACT FROM AUTHOR]

In the present study, Roman Catholic deacons at one of the 216 Hispanic parishes across the U.S. reported on their parish sense of community (P-SOC), using the SCI-2, within the congregation. P-SOC was assessed among socioeconomic status of lower/working class (n = 109) or middle class (n = 107) Latino parishes, located in either an urban (n = 152) or urban cluster (n = 64) site, with the number of families within the parish to reflect a tiny (n = 76), small (n = 46), moderate (n = 38), or large (n = 54) size. A 2 × 2 × 4 MANOVA on four P-SOC sub-scale scores found no significant main or interaction effect for status, site, or size. It appears per public perception that a sense of connectedness and closeness exists in the Hispanic parishes that are poor, urban, and large congregations is a myth at best. [ABSTRACT FROM AUTHOR]

In the United States, more than 1 in 5 households with children are unable to access and provide adequate food for a healthy, active lifestyle. We argue that the contribution of local context for food insecurity risk has largely been overlooked in favor of focusing on individual family characteristics, and that this is problematic given that mitigating food insecurity may be a communal process. We examine the relevance of neighborhood contributors to food insecurity among children, utilizing geocoded and nationally-representative data from the ECLS-K: 2010-2011 kindergarten cohort. We find little evidence that neighborhood socioeconomic, food retail, or social services characteristics directly impact food insecurity risk. However, our results reveal that family and neighborhood socioeconomic characteristics combine to impact food insecurity in ways consistent with a disadvantage paradox. As neighborhood concentrated disadvantage increases, higher-SES families’ risk of food insecurity increases, but lower-SES families’ risk decreases. This paradox is not explained by a higher concentration of social service organizations in more disadvantaged neighborhoods, and we theorize that impoverished families with children may share information and resources in disadvantaged communities to avoid food insecurity. [ABSTRACT FROM AUTHOR]

This study investigated interim assessments effects on the achievement gap. The data were collected from a field experiment conducted in 2010–2011 in K-8 public schools in Indiana in the U.S. Two-level models were utilized to determine whether interim assessments interacted with student SES, race, level of prior achievement, gender, school composition and urbanicity. The results are overall mixed. The majority of the interaction effects are close to zero and statistically non-significant. However, the treatment may have helped reduce the gender and race gaps in reading and mathematics in grades 3–8. The treatment may also have helped reduce the achievement gap between middle- and high-achievers in grades 3–8. The interactions between interim assessments and school composition and urbanicity were overall non-significant. [ABSTRACT FROM AUTHOR]

Lesbian women engage in more hazardous drinking than heterosexual women yet we know relatively little about what explains this disparity. In the present study, race, socioeconomic status (SES), minority stress, general psychological processes, and distress were examined as pathways to hazardous drinking among young (18–35 years) Black and non-Hispanic White lesbian women. We used the psychological mediation framework adaptation of minority stress theory and the reserve capacity model as theoretical underpinnings of the conceptual model in the current study. Self-identified lesbian participants (N = 867) completed a onetime online survey that assessed race, SES, perceived sexual minority discrimination, proximal minority stress (concealment, internalized homophobia, lack of connection to lesbian community), rumination, social isolation, psychological distress, drinking to cope, and hazardous drinking. Cross-sectional results demonstrated that being Black was associated with hazardous drinking via sequential mediators of rumination, psychological distress, and drinking to cope. SES was associated with hazardous drinking via sequential mediators of sexual minority discrimination, proximal minority stress, rumination, social isolation, psychological distress, and drinking to cope. Understanding these pathways can aid researchers and clinicians studying and working with lesbians who are at risk for hazardous drinking. [ABSTRACT FROM AUTHOR]

Prior work suggests that income inequality depresses civic participation among adults. However, associations between income inequality and youth civic engagement have not been assessed. This is true despite evidence that other features of communities influence youth civic development. To fill the gap, we examine associations between county-level income inequality and civic engagement among a nationally representative sample of 12,240 15-year-olds (50 % female). We find opposite patterns than those suggested by the adult literature. Higher county-level income inequality is associated with slightly more civic engagement (greater importance of helping others, higher rates of volunteering often), and this is particularly true for low-socioeconomic status and racial/ethnic minority youth. Potential developmental and structural explanations for these differences are offered. In addition, practical implications of these findings are drawn, and future research directions for scholars studying youth are proposed. [ABSTRACT FROM AUTHOR]

Differences in socioeconomic status (SES), including income, education, and employment, continue to be significant contributors to health disparities in the United States (US), including disparities in mental health outcomes. Despite the size and diversity of the Latinx population, there is a lack of literature describing differences in mental health outcomes, including psychological distress, for Latinx subgroups (e.g., Dominican, Puerto Rican, Cuban). Therefore, we used pooled data from the 2014-2018 National Health Interview Survey to examine variations in psychological distress among Latinx subgroups as compared to other Latinx subgroups and non-Latinx whites. Additionally, we conducted regression analyses and tested whether race/ethnicity modified the relationship between SES indicators and psychological distress. Findings indicate that individuals categorized as Dominican and Puerto Rican were among the Latinx subgroups with the highest levels of psychological distress when compared to other Latinx subgroups and non-Latinx whites. Additionally, results demonstrate that SES indicators, such as higher levels of income and education, were not necessarily significantly associated with lower levels of psychological distress for all Latinx subgroups when compared to non-Latinx whites. Our findings discourage the practice of making broad generalizations about psychological distress or its associations with SES indicators to all Latinx subgroups using results garnered from the aggregate Latinx category.

Background: Despite decreases in the use of illicit drugs in the United States, prescription medications have become a major category of substances used by young adults.Objective: This study examines the relationship between the socioeconomic status (SES) of young adult respondents (ages 24–32) and their history of nonmedical use of prescription medications (NUPM).Method: A secondary analysis was conducted with nationally representative data gathered from several waves (n = 15 701) of the National Longitudinal Study of Adolescent Health (Add Health). Four categories of NUPM were examined: (i) sedatives; (ii) tranquilizers; (iii) stimulants; and (iv) pain killers. SES was defined by several measures in the Add Health survey. Given the complex sampling plan of the Add Health, all analyses were weighted appropriately.Results: Results indicated higher levels of personal SES, such as having health insurance or not experiencing a financial hardship in the past year, decreased the likelihood of reporting lifetime NUPM. In contrast higher levels of parent SES (e.g. parental education) were associated with an increased likelihood of reporting lifetime use of NUPM tranquilizers and stimulants.Conclusions: The results of this study suggest parental SES may have a stronger influence over NUPM than personal levels of SES, particularly for the categories of tranquilizers and stimulants. Furthermore, these findings indicate more research is needed on this subject to better understand the NUPM epidemic in order to effectively develop comprehensive clinical, public health, and policy-related intervention and prevention approaches. [ABSTRACT FROM PUBLISHER]

In what is known as Simpsons Paradox, a statistical association present within different groups becomes reversed when the groups are aggregated. Because race is confounded with socioeconomic status (SES) in the U.S., the overall smoking rate among Blacks may exceed that among Whites, even while the reverse is true within SES strata (or when adjusting for SES). Indeed, in the most recent five iterations of the Behavioral Risk Factor Surveillance System (2008-2012), a nationwide dataset, unadjusted models found that non-Hispanic Blacks were more likely than non-Hispanic Whites to report current smoking (e.g., in 2012: OR=1.14, p<.0001). However, Blacks were less likely than Whites to report smoking across all five years when models adjusted for income (e.g., in 2012: OR=0.85, pc.0001) and in 2008-2010 when models adjusted for education. This reversal of association reflects racial disparities in SES, which cause Black Americans to be disproportionately affected by smoking risk factors associated with low income and education. [ABSTRACT FROM AUTHOR]

Mothers of 126 infants, 54 lower-socioeconomic status (SES) infants (26 younger, 4–11 months; 28 older, 12–19 months) and 72 middle-SES infants (12–17 months), answered questionnaires about their infants' typical television (TV) watching and interest, the frequency of their independent play with toys and dyadic play with and without toys, and whether or not the TV was typically on in the room at the time. Although infants spent little time actively watching TV, the majority of mothers in all groups reported the TV typically turned on in the room at least half the time during all types of play. Mothers reported middle-SES infants engaged more frequently in individual and dyadic toy play, but lower-SES infants were more often exposed to background TV/video during play. Because play is important to infant development and background TV can disrupt it, these findings raise concerns, particularly for infants residing in lower-SES households. [ABSTRACT FROM AUTHOR]

As consumption expenditures are increasingly recognized as direct measures of children's material well-being, they provide new insights into the process of intergenerational transfers from parents to children. Little is known, however, about how parents allocate financial resources to individual children. To fill this gap, we develop a conceptual framework based on stratification theory, human capital theory, and the child-development perspective; exploit unique child-level expenditure data from Child Supplements of the PSID; and employ quantile regression to model the distribution of parental spending on children. Overall, we find strong evidence supporting our hypotheses regarding the effects of socioeconomic status (SES), race, and parental expectation. Our nuanced estimates suggest that (1) parental education, occupation, and family income have differential effects on parental spending, with education being the most influential determinant; (2) net of SES, race continues to be a significant predictor of parental spending on children; and (3) parental expectation plays a crucial role in determining whether parents place a premium on child development in spending and how parents prioritize different categories of spending. [ABSTRACT FROM AUTHOR]

Links between schools' demographic composition and students' achievement have been a major policy interest for decades. Using a racially/ethnically diverse sample from the National Longitudinal Study of Adolescent Health ( N = 6,302; 54 % females; 53 % White, 21 % African American, 15 % Latino, 8 % Asian American, 2 % other race/ethnicity), we examined the associations between demographic marginalization, students' later social integration (loneliness at school, school attachment), and educational performance and attainment. Adolescents who were socioeconomically marginalized at school [i.e., having <15 % same-socioeconomic status (SES) peers] had lower cumulative grade point averages across high school and lower educational attainment. A similar disadvantage was observed among students who were both socioeconomically and racially/ethnically marginalized at school (i.e., having <15 % same-SES peers and <15 % same-racial/ethnic peers). Indirect effects were also observed, such that demographic marginalization was linked to poorer school attachment, and poorer school attachment, in turn, was related to poorer academic performance. These results highlight the educational barriers associated with demographic marginalization and suggest potential targets for future intervention efforts. [ABSTRACT FROM AUTHOR]

Determining whether population dynamics provide competing explanations to place effects for observed geographic patterns of population health is critical for understanding health inequality. We focus on the working-age population-the period of adulthood when health disparities are greatest-and analyze detailed data on residential mobility collected for the first time in the 2000 U.S. census. Residential mobility over a five-year period is frequent and selective, with some variation by race and gender. Even so, we found little evidence that mobility biases cross-sectional snapshots of local population health. Areas undergoing large or rapid population growth or decline may be exceptions. Overall, place of residence is an important health indicator; yet, the frequency of residential mobility raises questions of interpretation from etiological or policy perspectives, complicating simple understandings that residential exposures alone explain the association between place and health. Psychosocial stressors related to contingencies of social identity associated with being black, urban, or poor in the United States may also have adverse health impacts that track with structural location even with movement across residential areas. [ABSTRACT FROM AUTHOR]

Youth who experience adverse environments in early life initiate sexual activity at a younger age, on average, than those from more advantaged circumstances. Evolutionary theorists have posited that ecological stress precipitates earlier reproductive and sexual onset, but it is unclear how stressful environments interact with genetic influences on age at first sex. Using a sample of 1,244 pairs of twins and non-twin full siblings from the National Longitudinal Study of Adolescent Health, the present study tested for gene-by-environment interactions (G X E) on age at first sex (AFS). Multivariate interaction models indicated that genetic influences on AFS were suppressed among low-socioeconomic-status (SES) and ethnic-minority compared with higher SES and ethnic-majority youth. Father absence did not uniquely moderate genetic influences on AFS. These results are broadly consistent with previous findings that genetic influences are minimized among individuals whose environments are characterized by elevated risk; however, future research would benefit from samples with larger numbers of individuals at the very low end of the SES spectrum. [ABSTRACT FROM AUTHOR]

Extensive research documents the relevance of families and socioeconomic resources to health. This article extends that research to sexual minorities, using 12 years of the National Health Interview Survey (N = 460,459) to examine self-evaluations of health among male and female adults living in same-sex and different-sex relationships. Adjusting for socioeconomic status eliminates differences between same- and different-sex cohabitors so that they have similarly higher odds of poor health relative to married persons. Results by gender reveal that the cohabitation disadvantage for health is more pronounced for different-sex cohabiting women than for men, but little difference exists between same-sex cohabiting men and women. Finally, the presence of children in the home is more protective for women’s than men’s health, but those protections are specific to married women. In all, the results elucidate the importance of relationship type, gender, and the presence of children when evaluating health. [ABSTRACT FROM PUBLISHER]

Summary: Among a group of 940 US adults, economic adversity and minority race status were associated with higher serum levels of markers of bone turnover. These results suggest that higher levels of social stress may increase bone turnover. Introduction: To determine socioeconomic status (SES) and race differences in levels of bone turnover. Methods: Using data from the Biomarker Substudy of the Midlife in the US (MIDUS) study (491 men, 449 women), we examined cross-sectional associations of SES and race with serum levels of bone turnover markers (bone-specific alkaline phosphatase [BSAP], procollagen type I N-terminal propeptide [PINP], and N-telopeptide [Ntx]) separately in men and women. Linear multivariable regression was used to control for body weight, menopausal transition stage, and age. Results: Among men, low family poverty-to-income ratio (FPIR) was associated with higher turnover, but neither education nor race was associated with turnover. Men with FPIR <3 had 1.808 nM BCE higher Ntx ( P = 0.05), 3.366 U/L higher BSAP ( P = 0.02), and 7.066 higher PINP ( P = 0.02). Among women, neither education nor FPIR was associated with bone turnover, but Black women had 3.688 nM BCE higher Ntx ( P = 0.001), 5.267 U/L higher BSAP ( P = 0.005), and 11.906 μg/L higher PINP ( P = 0.008) compared with non-Black women. Conclusions: Economic adversity was associated with higher bone turnover in men, and minority race status was associated with higher bone turnover in women, consistent with the hypothesis that higher levels of social stresses cause increased bone turnover. The magnitude of these associations was comparable to the effects of some osteoporosis medications on levels of turnover. [ABSTRACT FROM AUTHOR]

Health inequalities, which have been well documented for decades, have more recently become policy targets in developed countries. This review describes time trends in health inequalities (by sex, race//ethnicity, and socioeconomic status), commitments to reduce health inequalities, and progress made to eliminate health inequalities in the United States, United Kingdom, and other OECD countries. Time-trend data in the United States indicate a narrowing of the gap between the best- and worst-off groups in some health indicators, such as life expectancy, but a widening of the gap in others, such as diabetes prevalence. Similarly, time-trend data in the United Kingdom indicate a narrowing of the gap between the best- and worst-off groups in some indicators, such as hypertension prevalence, whereas the gap between social classes has increased for life expectancy. More research and better methods are needed to measure precisely the relationships between stated policy goals and observed trends in health inequalities. [ABSTRACT FROM AUTHOR]

Background: In 2007 the Centers for Disease Control and Prevention (CDC) reported a higher prevalence of autism spectrum disorder (ASD) in New Jersey, one of the wealthiest states in the United States, than in other surveillance regions.Objective: To examine the association of socioeconomic status (SES) with ASD prevalence.Methods: Information on eight-year-olds with ASD from four counties was abstracted from school and medical records. US Census 2000 provided population and median household income data.Results: 586 children with ASD were identified: autism prevalence was 10.2/1000, higher in boys than girls (16 vs. 4/1000); higher in white and Asian non-Hispanics than in black non-Hispanics and Hispanics (12.5, 14.0, 9.0, and 8.5/1000, respectively); and higher (17.2/1000 (95% CI 14.0–21.1)) in tracts with median income >US$90,000 than in tracts with median income ≤US$30,000 (7.1 (95% CI 5.7–8.9)). Number of professional evaluations was higher, and age at diagnosis younger, in higher income tracts (p < .001), but both measures spanned a wide overlapping range in all SES levels. In multivariable models race/ethnicity did not predict ASD, but the prevalence ratio was 2.2 (95% CI 1.5–3.1) when comparing highest with lowest income tracts.Conclusions: In the US state of New Jersey, ASD prevalence is higher in wealthier census tracts, perhaps due to differential access to pediatric and developmental services. [ABSTRACT FROM AUTHOR]

This paper presents new estimates of sibling correlations in health and socioeconomic outcomes over the life course in the U.S. Sibling correlations provide an omnibus measure of the importance of all family and community influences. I find that sibling correlations in a range of health and socioeconomic outcomes start quite high at birth and remain high over the life course. The sibling correlation in birth weight is estimated to be 0.5. Sibling correlations in test scores during childhood are as high as 0.6. Sibling correlations in adult men's wages are also around 0.5. Decompositions provide suggestive evidence on which pathways may account for the gradients in health and SES by family background. For example, sibling correlations in cognitive skills and non-cognitive skills during childhood are lower controlling for family income. Similarly, parent education levels can account for a sizable portion of the correlation in adult health status among brothers. [ABSTRACT FROM AUTHOR]

Abstract: A large body of research shows that social determinants of health have significant impact on the health of Canadians and Americans. Yet, very few studies have directly compared the extent to which social factors are associated with health in the two countries, in large part due to the historical lack of comparable cross-national data. This study examines differences in the effect of a wide-range of social determinants on self-rated health across the two populations using data explicitly designed to facilitate comparative health research—Joint Canada/United States Survey of Health. The results show that: 1) sociodemographic and socioeconomic factors have substantial effects on health in each country, though the size of the effects tends to differ—gender, nativity, and race are stronger predictors of health among Americans while the effects of age and marital status on health are much larger in Canada; the income gradient in health is steeper in Canada whereas the education gradient is steeper in the U.S.; 2) Socioeconomic status (SES) mediates or links sociodemographic variables with health in both countries—the observed associations between gender, race, age, and marital status and health are considerably weakened after adjusting for SES; 3) psychosocial, behavioural risk and health care access factors are very strong determinants of health in each country, however being severely/morbidly obese, a smoker, or having low life satisfaction has a stronger negative effect on the health of Americans, while being physically inactive or having unmet health care needs has a stronger effect among Canadians; and 4) risk and health care access factors together play a relatively minor role in linking social structural factors to health. Overall, the findings demonstrate the importance of social determinants of health in both countries, and that some determinants matter more in one country relative to the other. [Copyright &y& Elsevier]

Objectives: To investigate the correlates of body mass index (BMI) among a national sample of older adults in the United States. Method: Data used in these analyses were part of the 2003-2004 National Health and Nutrition Examination Survey (NHANES). Generalized ordered logistic regression was used to analyze difference between normal weight, overweight, moderately obese, and severely obese adults (n = 1,143) above the age of 65 years. Results: A higher BMI was more common among those with greater activities of daily living (ADL) limitations, greater use of prescription medicines (≥7), greater number of cardiovascular-related disorders (1 or ≥2), and those aged 65 to 74 years. Discussion: The findings acknowledge relationships between health characteristics, disability, and BMI among a national sample of older adults. These results suggest that prevention and management of health conditions, basic ADL, and BMI may be reasonable targets for intervention. [ABSTRACT FROM PUBLISHER]

Summary: Disparities in the occurrence and outcomes of chronic kidney disease (CKD) are associated with individual and community socioeconomic (SES) risk factors. The pathways by which SES contribute to increased CKD risk are under active investigation and access to adequate health care appears to be an important contributor to these disparities. Changes in the US health system have eliminated barriers to access for end-stage renal disease care for most US citizens and reduced disparities in outcomes of care after the onset of renal replacement therapy. The purpose of this review is to summarize the empiric evidence for the association between SES and disparities in CKD occurrence and outcomes of care and to describe existing and planned interventions to reduce these SES-associated variations in CKD care. In particular, we describe a 10-state pilot project initiated by the Centers for Medicare and Medicaid Services in August of 2008 to reduce disparities and improve the detection and treatment of early diabetic kidney disease. This pilot project represents an important step in developing interventions to reduce CKD disparities in the US health care system. [ABSTRACT FROM AUTHOR]

Background: Population-based cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute (NCI) are mainly based on medical records and administrative information. Individual-level socioeconomic data are not routinely reported by cancer registries in the United States because they are not available in patient hospital records. The U.S. representative National Longitudinal Mortality Study (NLMS) data provide self-reported, detailed demographic and socioeconomic data from the Social and Economic Supplement to the Census Bureau's Current Population Survey (CPS). In 1999, the NCI initiated the SEER-NLMS study, linking the population-based SEER cancer registry data to NLMS data. The SEER-NLMS data provide a new unique research resource that is valuable for health disparity research on cancer burden. We describe the design, methods, and limitations of this data set. We also present findings on cancer-related health disparities according to individual-level socioeconomic status (SES) and demographic characteristics for all cancers combined and for cancers of the lung, breast, prostate, cervix, and melanoma.Methods: Records of cancer patients diagnosed in 1973-2001 when residing 1 of 11 SEER registries were linked with 26 NLMS cohorts. The total number of SEER matched cancer patients that were also members of an NLMS cohort was 26,844. Of these 26,844 matched patients, 11,464 were included in the incidence analyses and 15,357 in the late-stage diagnosis analyses. Matched patients (used in the incidence analyses) and unmatched patients were compared by age group, sex, race, ethnicity, residence area, year of diagnosis, and cancer anatomic site. Cohort-based age-adjusted cancer incidence rates were computed. The impact of socioeconomic status on cancer incidence and stage of diagnosis was evaluated.Results: Men and women with less than a high school education had elevated lung cancer rate ratios of 3.01 and 2.02, respectively, relative to their college educated counterparts. Those with family annual incomes less than $12,500 had incidence rates that were more than 1.7 times the lung cancer incidence rate of those with incomes $50,000 or higher. Lower income was also associated with a statistically significantly increased risk of distant-stage breast cancer among women and distant-stage prostate cancer among men.Conclusions: Socioeconomic patterns in incidence varied for specific cancers, while such patterns for stage were generally consistent across cancers, with late-stage diagnoses being associated with lower SES. These findings illustrate the potential for analyzing disparities in cancer outcomes according to a variety of individual-level socioeconomic, demographic, and health care characteristics, as well as by area measures available in the linked database. [ABSTRACT FROM AUTHOR]

Background: Relatively little is known about social inequality in human papillomavirus (HPV) vaccination among teenagers in the United States. This study aims to investigate whether there is a social disparity in HPV vaccination among teenagers and if so, whether it can differ according to the source of teen vaccination information (parental reports and provider records). Methods: We used the data from the 2019 National Immunization Survey-Teen (NIS-Teen; 42,668 teenagers, aged 13–17) including parent-reported vaccination status. Among them, 18,877 teenagers had adequate provider-reported vaccination records. Two socioeconomic status (SES) measures were used: mother's education and annual family income. Multivariate logistic analyses were conducted. Results: False negatives of parental reports against provider records were more than two times higher (p < 0.001) in low-SES teens than in high-SES teens. In both SES measures, the proportion of HPV-unvaccinated teenagers was lowest at the highest SES level in analyses with parental reports. However, it was the opposite in analyses with provider records. Interestingly, regardless of the vaccination information source, the HPV unvaccinated rate was highest in the middle-SES teens (>12 years, non-college graduates; above poverty level, but not >USD 75 K). Conclusions: Significant social inequality in HPV vaccination among teenagers exists in the United States. The pattern of social inequality in HPV vaccination can be distorted when only parent-reported vaccination information is used. [ABSTRACT FROM AUTHOR]

Data from the 1997 cohort of the National Longitudinal Survey of Youth were used to assess the association between family, self, proximate extra-familial, and distal extra-familial system factors and abstinence/virginity and age of first sexual intercourse (N=1,854). In addition to family, findings point to the robustness of sociodemographic correlates of gender, race/ethnicity, and SES on abstinence and timing of sexual initiation. [ABSTRACT FROM AUTHOR]

Abstract: We focus on physical and psychosocial job characteristics as mediators in the link between education, earnings, and occupational standing and self-assessed overall health, cardiovascular and musculoskeletal health problems, and depression. From sociological research on the stratification of employment outcomes, we expect that people with less education also have lower earnings and lower levels of occupational standing, and have more physically and psychosocially demanding jobs. From the occupational stress, ergonomics, and job design literatures, we expect that physically and cognitively demanding jobs and jobs with varying amounts of control are associated with health outcomes. Consequently, we expect to find that job characteristics play an important mediating role in associations between SES and health. To address these hypotheses, we use data on sibling pairs from the Wisconsin Longitudinal Study. We find support for our hypotheses, although the extent to which job characteristics mediate SES–health relationships varies across health outcomes and by gender. [Copyright &y& Elsevier]

BACKGROUND: Epidemiologic studies suggest that there may be an association between environmental exposure to persistent organic pollutants (POPs) and diabetes. OBJECTIVE: The aim of this study was to test the hypothesis that residential proximity to POP-contaminated waste sites result in increased rates of hospitalization for diabetes. METHODS: We determined the number of hospitalized patients 25-74 years of age diagnosed with diabetes in New York State exclusive of New York City for the years 1993-2000. Descriptive statistics and negative binomial regression were used to compare diabetes hospitalization rates in individuals who resided in ZIP codes containing or abutting hazardous waste sites containing POPs ("POP" sites); ZIP codes containing hazardous waste sites but with wastes other than POPs ("other" sites); and ZIP codes without any identified hazardous waste sites ("clean" sites). RESULTS: Compared with the hospitalization rates for diabetes in clean sites, the rate ratios for diabetes discharges for people residing in POP sites and "other" sites, after adjustment for potential confounders were 1.23 [95% confidence interval (CI), 1.15-1.32] and 1.25 (95% CI, 1.16-1.34), respectively. In a subset of POP sites along the Hudson River, where there is higher income, less smoking, better diet, and more exercise, the rate ratio was 1.36 (95% CI, 1.26-1.47) compared to clean sites. CONCLUSIONS: After controlling for major confounders, we found a statistically significant increase in the rate of hospitalization for diabetes among the population residing in the ZIP codes containing toxic waste sites. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated a strong association between minority race, low socioeconomic status (SES), and lack of potential access to care (e.g., no insurance coverage and no regular source of care) and poor receipt of health care services. Most studies have examined the independent effects of these risk factors for poor access, but more practical models are needed to account for the clustering of multiple risks.To present aprofileof risk factors for poor access based on income, insurance coverage, and having a regular source of care, and examine the association of the profiles with unmet health care needs due to cost. Relationships are examined by race/ethnicity.Analysis of 32,374 adults from the 2000 National Health Interview Survey.Reported unmet needs due to cost: missing/delaying needed medical care, and delaying obtaining prescriptions, mental health care, or dental care.Controlling for personal demographic and community factors, individuals who were low income, uninsured, and had no regular source of care were more likely to miss or delay needed health care services due to cost. After controlling for these risk factors, whites were more likely than other racial/ethnic groups to report unmet needs. When presented as a risk profile, a clear gradient existed in the likelihood of having an unmet need according to the number of risk factors, regardless of racial/ethnic group.Unmet health care needs due to cost increased with higher risk profiles for each racial and ethnic group. Without attention to these co-occurring risk factors for poor access, it is unlikely that substantial reductions in disparities will be made in assuring access to needed health care services among vulnerable populations. [ABSTRACT FROM AUTHOR]

Objective. To explore the associations among ethnicity, educational attainment, and cortisol secretion. Design. Participants included 63 white (n = 3)) and African-American (n = 32) adult men and women. Subjects provided salivary cortisol samples immediately upon awakening and again, 30 minutes later. Results, Analyses adjusted for relevant covariates revealed a steeper awakening response among whites with higher education compared to other groups. Cortisol levels were significantly lower among African-American participants with lower levels of education. All effects were independent of perceived stress. Conclusions. These preliminary findings demonstrate significant ethnic and education-related differences in awakening cortisol secretion responses. Our data highlight the importance of considering ethnicity and the moderating effects of social class when examining the associations among social contextual factors anti cortisol secretion. [ABSTRACT FROM AUTHOR]

We investigated the association between selected infant and maternal characteristics and autism risk. Children with autism born in California in 1989-1994 were identified through service agency records and compared with the total population of California live births for selected characteristics recorded on the birth certificate. Multivariate models were used to generate adjusted risk estimates. From a live birth population of more than 3.5 million, 4381 children with autism were identified. Increased risks were observed for males, multiple births, and children born to black mothers. Risk increased as maternal age and maternal education increased. Children born to immigrant mothers had similar or decreased risk compared with California-born mothers. Environmental factors associated with these demographic characteristics may interact with genetic vulnerability to increase the risk of autism. [ABSTRACT FROM AUTHOR]