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Objectives: Minorities’ Diminished Returns (MDRs) refers to the weaker protective health effects of socioeconomic status (SES) for minorities, particularly educational attainment for racial and ethnic minorities, compared to the general population. This pattern has been documented among African-Americans compared to Whites, however, we know very little about MDRs for educational attainment on disability among Hispanics compared to Non-Hispanic Whites. Aims: This cross-sectional study explored ethnic variation in the effects of educational attainment on severity of disability in the United States of America (USA). Materials and Methods: The 2015 National Health Interview Survey (NHIS) was a national survey of the general population in the USA. The total sample was 1021 American adults that reported some disability. Of the 1021 participants, 855 identified as Non-Hispanic and 165 identified as Hispanic. The independent variable was educational attainment. The main outcome was severity of disability measured using self-reported data. Age, gender, and race were covariates. Ethnicity was the effect modifier. Results: Among individuals with a disability, higher levels of educational attainment were associated with fewer disabilities, independent of all confounders. When ethnicity and educational attainment were interacted on severity of disability, the results indicated a smaller protective effect for Hispanics than for Non-Hispanics with a disability. Ethnicity-stratified models showed an effect for Non-Hispanics but not for Hispanics. Conclusions: The protective effects of educational attainment against severity of disability are smaller for Hispanics than for Non-Hispanics. To prevent health disparities, there is a need to minimize MDRs of SES for ethnic minorities. To do so, there is a need for innovative economic, public, and social policies that are not limited to equalizing educational attainment but that also help minorities leverage their resources and gain tangi

To investigate racial and ethnic differences in the protective effects of parental education and marital status against adolescents’ depressed mood and suicidal attempts in the U.S. As proposed by the Marginalization-related Diminished Returns (MDRs), parental education generates fewer tangible outcomes for non-White compared to White families. Our existing knowledge is very limited regarding diminished returns of parental education and marital status on adolescents’ depressed mood and suicidal attempts. To compare racial groups for the effects of parental education and marital status on adolescents’ depressed mood and suicidal attempt. This cross-sectional study included 7076 non-Hispanic White or African American 8-11 years old adolescents from the Adolescent Brain Cognitive Development (ABCD) study. The independent variables were parental education and marital status. The main outcomes were depressed mood and suicidal attempts based on parents’ reports using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Age and gender were the covariates. Race was the moderator. Logistic regression was used to analyze the ABCD data. Overall, parental education was associated with lower odds of depressed mood (OR = 0.81; 95% CI = 0.67–0.99; p = 0.037) and having married parents was associated with lower odds of suicidal attempts (OR = 0.50; 95% CI = 0.28–0.91; p = 0.022). In the pooled sample, we found interaction terms between race with parental education and marital status on the outcomes, suggesting that the protective effect of having married parents against depressed mood (OR = 1.54; 95% CI = 1.00–2.37; p = 0.048) and the protective effect of having married parents against suicidal attempts (OR = 6.62; 95% CI = 2.21–19.86; p = 0.001) are weaker for African Americans when compared to Whites. The protective effects of parent education and marital status against depressed mood and suicidal attempts are diminished for African American adolescents compare

Objectives: Despite our knowledge on the effect of cognitive test score on subsequent risk of mortality, few studies have compared Blacks and Whites for this association. The current study was conducted on Black-White differences in the magnitude of the association between baseline cognitive test score and all-cause mortality in a nationally representative sample of adults in the United States over 25 years. Methods: We used data of the Americans’ Changing Lives Study (ACL), 1986 – 2011, a national prospective cohort in U.S. The study followed 3,361 adults (2,205 White and 1,156 Blacks), age 25 and older, for up to 25 years. The independent variable was cognitive test score measured at baseline (1986) using the 4-item version of the Short Portable Mental Status Questionnaire, treated in two different ways (as a dichotomous and as a continuous variable). The dependent variable was time to death (due to all causes) during the follow up period. Covariates included baseline age, gender, education, income, number of chronic diseases, self-rated health, and depressive symptoms. Race (Black versus White) was the focal effect modifier. We used a series of Cox proportional hazards models in the total sample, and by race, in the absence and presence of health variables. Results: Overall, cognitive test score predicted mortality risk. A significant interaction was found between race and baseline cognitive test score suggesting that baseline cognitive test score has a weaker protective effect against all-cause mortality for Blacks in comparison to Whites. In race-stratified models, cognitive test score at baseline predicted risk of all-cause mortality for Whites but not Blacks, in the absence and presence of baseline socio-economic and health variables. The results were similar regardless of how we treated baseline cognitive test score. Conclusions: In the United States, baseline cognitive test score has a weaker protective effect against all-cause mortality over a long period

Background: Education level reduces the risk of health problems such as poor self-rated health (SRH), high body mass index (BMI), and depressive symptoms (DS). Marginalization – related Diminished Returns (MDRs), however, refer to smaller health benefits of socioeconomic status (SES) indicators particularly educational attainment for the members of racial minority groups such as non-Hispanic Blacks compared to the majority group (non-Hispanic Whites). It is not known, however, if MDRs also hold for middle-age and older adults over a long period of time.  Aims: The current study used a nationally representative data set to explore racial variation in the predictive utility of baseline education level on protecting people against poor SRH, BMI, and DS.  Methods: Data for this analysis were borrowed from the Health and Retirement Study (HRS 1992-ongoing), a nationally representative longitudinal study that followed 10,023 middle-aged and older adults (50+ years old) for up to 26 years. From this number, 1877 (18.7%) were non-Hispanic Black Americans, and 8,146 (81.3%) were non-Hispanic White Americans. Education level was the independent variable. We used cluster analysis to categorize individuals to low and high-risk groups (outcome) based on SRH, BMI, and DS over 26 years. Age and gender were the covariates. Race was the moderator.  Results: Overall, high education level reduced the odds of poor SRH, BMI, and DS over the 26 years of follow up. Interactions were observed between race and education on all three health outcomes indicating smaller protective effects of baseline educational attainment on poor health over time, regardless of the outcome.  Conclusions: In line with the MDRs, highly educated non-Hispanic Black Americans remain at high risk for poor health across domains, a risk which is unexpected given their education. The risk of all health outcomes, however, is lowest for non-Hispanic White Americans with highest education. Policies th

Sharon Cobb,1 Arash Javanbakht,2 Ebrahim Khalifeh Soltani,3 Mohsen Bazargan,4,5 Shervin Assari4 1School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA; 2Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA; 3Department of Political Science, Eastern Michigan University, Ypsilanti, MI, USA; 4Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA; 5Department of Family Medicine, UCLA, Los Angeles, CA, USACorrespondence: Shervin Assari Email assari@umich.eduBackground: Although health is a prerequisite for happiness, the salience of health for maintaining happiness may be diminished for Blacks when compared to Whites, a phenomenon which can be explained by the Black-White mental health paradox and minorities’ diminished returns.Aim: To understand if Black and White adult Americans differ in the effects of self-rated health (SRH) on happiness.Methods: This cross-sectional study used data from the General Social Survey (GSS; 1972– 2018), a nationally representative survey in the US. Our analytical sample included 42,201 Black and White adults. The independent variable was SRH. Happiness was the dependent variable. Sociodemographic factors were covariates. Race was the moderator. Logistic regression was used to analyze the data without and with interaction terms between race and SRH.Results: Overall, good SRH was positively associated with happiness, however, there was a significant interaction between race/ethnicity and good SRH on the outcome (i.e. happiness) . This finding suggested that the boosting effect of good SRH on happiness is weaker for Black than White people.Conclusion: In the United States, due to a weaker concordance between good health and happiness, Blacks who have poor SRH are more likely to report happiness. At the same time, Whites who are healthy report happiness, however, Blacks who are healthy d

Shervin Assari,1 Ritesh Mistry,2 Cleopatra H Caldwell,2 Mohsen Bazargan1,3 1College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; 2Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA; 3Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, 90095, USACorrespondence: Shervin AssariDepartment of Family Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St., Los Angeles, CA 90059, USAEmail assari@umich.eduBackground: High parental educational attainment is protective against youth health risk behaviors such as tobacco use. According to the Marginalization-related Diminished Returns (MDRs) theory, however, higher parental education is less protective for marginalized groups relative to non-Hispanic Whites.Objective: To explore race/ethnic differences in the effects of parental educational attainment on cigarette smoking in a national sample of American adolescents.Methods: In a cross-sectional study, we used baseline data of 10,878 American youth who had participated in the Population Assessment of Tobacco and Health (PATH 2013). The independent variable was parental educational attainment. The dependent variables were lifetime cigarette smoking, current (past 30-day) cigarette moking, and daily cigarette smoking. Youth age, youth gender, and parental marital status were the covariates. Race/ethnicity was the moderating variable. Logistic regression model was used for data analysis.Results: Overall, a higher parental educational attainment was associated with a lower lifetime cigarette smoking, current (past 30-day) cigarette smoking, and daily cigarette smoking. Parental educational attainment showed significant interaction with race/ethnicity suggesting smaller protective effects of parental educational attainment on youth tobacco outcomes for Black and Hispanic than for non-Hispanic Whit