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BACKGROUND AND AIMS: Although actual and perceived obesity are associated, some research has shown that this association may differ across racial and ethnic groups. Accordingly, this cross-sectional study tested racial differences regarding the association between actual and perceived obesity among American adults. METHODS: The Health Information National Trends Survey (HINTS 5- Cycle 3) is a representative survey of American adults conducted in 2019. A total number of 3731 adults entered our analysis, including 3054 (81.9%) non-Hispanic Whites and 677 (18.1%) African Americans (AAs). The independent variable was actual obesity, which was defined as a body mass index of 30 or greater. The outcome was perceived as obesity. In addition, age, gender, marital status, education, and income were considered as control variables (confounders), and the race was the focal effect modifier. Finally, logistic regressions without and with interaction terms were utilized to analyze the data. RESULTS: Overall, actual and perceived obesity were associated, with obese individuals having higher odds of seeing themselves as obese (odds ratio [OR]=25.82, 95% CI=18.58–35.89, P< 0.001), indicating a weaker link between the two for AAs compared to non-Hispanic Whites. Race-stratified models also confirmed the same pattern with the actual and perceived obesity, showing a weaker association for AAs (OR=15.61, 95% CI=9.53–25.59, P

BACKGROUND. Black-White differences are reported in social, psychological, behavioral, medical, and biological correlates of depression. This study was conducted to compare Black and White older adults for the association between neuroticism polygenic risk score (N-PRS) and chronicity of depressive symptoms over 20 years. METHODS. Data came from the Health and Retirement Study (HRS), 1990 – 2012, a nationally representative sample of Americans above age 50. Current analysis followed 9,249 individuals (7,924 Whites and 1,325 Blacks) for up to 22 years. Depressive symptoms were measured every two years between 1992 and 2012 using the 8-item Center for Epidemiological Studies-Depression Scale (CES-D-8). The independent variable was N-PRS. The dependent variable was average depressive symptoms between 1992 and 2012. Linear regression was used for data analysis. RESULTS. In the pooled sample, higher N-PRS was associated with higher average depressive symptoms over the 20-year follow up period [b=0.01, 95%CI=0.00 to 0.04], net of all covariates. We also found an interaction between race and N-PRS [b=−0.02, 95%CI=−0.03 to 0.00], suggesting a stronger effect of N-PRS on 20-year average depressive symptoms for Whites than Blacks. Based on our race-specific linear regression models, higher N-PRS was associated with higher depressive symptoms from 1992 to 2012 for Whites [b=0.01, 95%CI=0.01 to 0.02] but not Blacks [b=0.00, 95%CI=−0.02 to 0.02]. CONCLUSION. Black and White older adults may differ in the salience of the existing N-PRS for depressive symptoms, which better reflects the burden of depression for Whites than Blacks. This may be because the existing PRSs are derived from mostly or exclusively White samples, limiting their applicability in other race groups. Racial variation in psychosocial, clinical, and biological correlates of depression needs further research.

Background: Parental educational attainment is protective against chronic medical conditions (CMCs). According to the minorities&rsquo, diminished returns (MDRs) theory, however, the health effects of socioeconomic status (SES) indicators are smaller for socially marginalized groups such as racial and ethnic minorities rather than Whites. Aims: To explore racial and ethnic differences in the effect of parental educational attainment on CMCs in a nationally representative sample of American youth. Methods: In this cross-sectional study, we used baseline data of 10,701 12&ndash, 17 years old youth in the Population Assessment of Tobacco and Health (PATH, 2013). Parental educational attainment was the independent variable. The dependent variable was the number of CMCs in youth. Age, gender, and family structure were covariates. Race and ethnicity were the focal moderators. Linear and multinomial regression were applied to analyze the data. Results: Overall, higher parental educational attainment was associated with a lower number of CMCs. Race and ethnicity, however, showed significant interactions with parental educational attainment on a number of CMCs as well as 2+ CMCs, suggesting that the effect of parenting educational attainment on CMCs is significantly smaller for Black and Hispanic than White youth. Conclusions: In the United States, race and ethnicity alter the health gains that are expected to follow parental educational attainment. While White youth who are from highly educated families are most healthy, Black and Hispanic youth from highly educated families remain at higher risk for CMCs. That means, while the most socially privileged group, Whites, gain the most health from their parental education, Blacks and Hispanics, the least privileged groups, gain the least. The result is a disproportionately high number of CMCs in middle-class Blacks and Hispanics. Economic, social, public, and health policy makers should be aware that health disparities are not all due to lower SES of the disadvantaged group but also diminished returns of SES resources for them. Youth physical health disparities due to race and ethnicity exist across all SES levels.

Background: Educational attainment is one of the strongest determinants of subjective health and well-being. Minorities&rsquo, Diminished Returns, however, suggests that such an effect may be smaller for the members of racial/ethnic minorities such as Blacks and Hispanics relative to non-Hispanic Whites. Only one study has previously shown that minorities&rsquo, diminished returns may also apply to lesbian, gay, and bisexual (LGB) individuals, however, that study has focused on other outcomes (i.e., obesity). Aims: To compare LGB and non-LGB American adults for the effects of educational attainment on subjective health and well-being. Methods: This cross-sectional study used baseline data of 31,480 adults in the Population Assessment of Tobacco and Health (PATH, 2013), a nationally representative study in the United States. The independent variable was educational attainment. The dependent variable was subjective health and well-being, measured using four items. Race, ethnicity, age, gender, poverty status, and employment were the covariates. LGB status was the moderator. Results: Overall, individuals with higher educational attainment had better subjective health and well-being. We found a significant interaction between LGB status and educational attainment which was suggestive of that the boosting effect of high educational attainment on better subjective health and well-being was systemically smaller for LGB than non-LGB individuals. Conclusions: In the United States, highly educated LGB adults experience poor subjective health and well-being, a status that is disproportionate to their educational attainment.

Purpose. This study investigated the effects of objective and subjective socioeconomic status (SES) indicators on two health behaviors, cigarette smoking and alcohol drinking, among African American older adults. Methods. This community-based study recruited 619 economically disadvantaged African American older adults (age &ge, 65 years) residing in South Los Angeles. Structured face-to-face interviews were conducted to collect data. Data on demographic factors (age and gender), subjective SES (financial difficulties), objective SES (educational attainment), living arrangement, marital status, healthcare access (insurance), and health (number of chronic medical conditions, self-rated health, sick days, depression, and chronic pain) and health behaviors (cigarette smoking and alcohol drinking) were collected from participants. Logistic regressions were used to analyze the data. Results. High financial difficulties were associated with higher odds of smoking cigarettes and drinking alcohol, independent of covariates. Educational attainment did not correlate with our outcomes. Similar patterns emerged for cigarette smoking and alcohol drinking. Conclusion. Subjective SES indicators such as financial difficulties may be more relevant than objective SES indicators such as educational attainment to health risk behaviors such as cigarette smoking and alcohol drinking among African American older adults in economically constrain urban environments. Smoking and drinking may serve as coping mechanisms with financial difficulty, especially among African American older adults. In line with the minorities&rsquo, diminished returns (MDR) theory, and probably due to discrimination against racial minorities, educational attainment has a smaller protective effect among economically disadvantaged African American individuals against health risk behaviors.

Background. Despite the prevalence of multimorbidity among African American (AA) older adults, little information exists on correlates of polypharmacy (using 5+ medications) in AA older adults. There is more information available regarding the link between polypharmacy and physical aspects of health than subjective ones. Aims. In a local sample of AA older adults in Los Angeles, this study investigated the association of polypharmacy with self-rated health (SRH) and depression. We also explored gender differences in these links. Methods. This community-based study was conducted in south Los Angeles. A total number of 708 AA older adults (age &ge, 55 years) were entered into this study. From this number, 253 were AA men and 455 were AA women. Polypharmacy was the independent variable. Self-rated health (SRH) and depression were the dependent variables. Age, educational attainment, financial difficulty (difficulty paying bills, etc.), and marital status were covariates. Gender was the moderator. Multimorbidity, measured as the number of chronic diseases (CDs), was the mediator. Logistic regressions were applied for data analysis. Results. Polypharmacy was associated with worse SRH and depression. Multimorbidity fully mediated the association between polypharmacy and depressive symptoms. Multimorbidity only partially mediated the association between polypharmacy and poor SRH. Gender moderated the association between polypharmacy and SRH, as polypharmacy was associated with poor SRH in women but not men. Gender did not alter the association between polypharmacy and depression. Conclusions. AA older women with polypharmacy experience worse SRH and depression, an association which is partially due to the underlying multimorbidity. There is a need for preventing inappropriate polypharmacy in AA older adults, particularly when addressing poor SRH and depression in AA older women with multimorbidity.

Life course epidemiological studies have documented the effects of family socioeconomic position (SEP) at birth on youth developmental processes and outcomes decades later. According to the minorities&rsquo, diminished returns (MDR) theory, however, family SEP at birth generates smaller returns for Black compared to White families. Using 15 years of follow up data of a national sample of American families, this study investigated racial differences in the effect of family income at birth on subsequent school bonding of the adolescent at age 15. The fragile families and child well-being study (FFCWS) is a 15-year prospective longitudinal study of 495 White and 1436 Black families from the birth of their child. Family SEP (poverty status) at birth was the independent variable. Youth school bonding at age 15 was the main outcome. Linear regressions were applied for data analysis, with race as the focal moderator. In the pooled sample, in addition to each race, higher family SEP at birth was associated with higher school bonding of the youth at age 15. Race altered the effects of family SEP at birth on youth school bonding at age 15, indicating smaller protective effects for Black compared to White youth. Race stratified regressions also showed the effect of family SEP at birth on age 15 school bonding for White youth, but not Black youth. Tangible outcomes that follow economic resources at birth are disproportionately smaller for Black families compared to those for White families. Merely equalizing SEP is not enough for the elimination of racial inequalities in youth outcomes. Policies should reduce societal and structural barriers that commonly cause diminished returns of SEP for Black families. Policy evaluations should aim for most effective policies that have the potential to equalize Blacks&rsquo, and Whites&rsquo, chances for gaining tangible developmental and health outcomes from identical SEP resources.

Background: Although high educational attainment is linked to better health and lower health risk behaviors, this effect may be systemically smaller for racial and ethnic minority groups compared to Whites. However, it is still unknown whether these diminished returns also apply to marginalization based on sexual orientation. Aims: In a national sample of adults which was composed of people of color, we compared straight and homosexual people for the association between education attainment and obesity. Methods: The Social Justice Sexuality Project (SJS-2010) is a cross-sectional national survey of health and wellbeing of predominantly people of color who identify as homosexual. The current analysis included 2884 adults (age 24 or more) who were either heterosexual (n = 260) or homosexual (n = 2624). The predictor variable was education attainment, and the outcome variable was obesity status (body mass index larger than 30 kg/m2 [kilograms per meter squared]). Demographic factors (age and gender), household income, nativity (US born vs. immigrant), and health (self-rated health and current smoking) were the covariates. Sexual orientation was the moderator. Results: In the pooled sample, high education attainment was protective against obesity status. Sexual orientation interacted with education attainment on odds of obesity, which was suggestive of stronger protective effects of high education attainment against obesity for heterosexual than homosexual individuals. Conclusion: High education attainment better protects heterosexual than homosexual people against obesity, a pattern similar to what has been observed for comparison of Whites and non-Whites. Smaller protective effects of education attainment on health behaviors of marginalized people are possibly, due to prejudice and discrimination that they experience. Discrimination may minimize stigmatized individuals&rsquo, abilities to mobilize their economic and human resources and translate them to tangible outcomes. This finding extends the Minorities&rsquo, Diminished Returns theory, suggesting that it is not just race/ethnicity but possibly any marginalizing and stigmatizing social identity that results in diminished returns of socioeconomic status resources.

BACKGROUND. As suggested by the Minorities’ Diminished Returns (MDR) theory, socioeconomic status (SES) systemically results in smaller outcomes for non-Whites compared to Whites. We still know very little about diminished trans-generational returns of SES resources such as parental educational attainment (PEA). PURPOSE. This cross-sectional study explored racial variation in the effect of PEA on the college students’ grade point average (GPA) in the US. METHODS. The Healthy Mind Study (HMS, 2016–2017) is a national telephone of college students in the US. The total sample was 18,072 domestic undergraduate college students who were either non-Hispanic Whites (n = 16,718; %92.50) or non-Hispanic Blacks (n = 1,354; %7.50). The independent variable was PEA. The main outcome was GPA measured using self-reported data. Age, gender, sexual orientation, transgender status, and financial difficulty were covariates. Race/ethnicity was the effect modifier. Linear regression models were used to analyze the data. RESULTS. Overall, higher PEA was associated with a higher GPA, independent of all possible confounders. Race/ethnicity, however, showed a significant interaction with PEA on students’ GPA, indicating a smaller positive effect of PEA on non-Hispanic Blacks compared to non-Hispanic Whites college students’ GPA. Race/ethnicity stratified models also showed a larger effect for White than Black students. CONCLUSIONS. The boosting effect of PEA in GPA is smaller for Black compared to White college students. US should systematically reduce extra costs of upward social mobility for racial and ethnic minority families.

BACKGROUND AND OBJECTIVES: As suggested by the Minorities’ Diminished Return theory, the association between socioeconomic status and health is weaker for racial and ethnic minorities compared to Whites. The current study compared Blacks and Whites in terms of the association between marital status and physical health. METHODS: The State of the State Survey (2017) included 881 adults (92 Blacks and 782 Whites) generalizable to the state of Michigan, the United States. The marital status and self-rated physical health (SRPH), which was measured using a single item, were considered as independent and dependent variables, respectively. In addition, age, gender, education, and employment were covariates. Race/ethnicity was regarded as the moderating factor. Logistic regression was used for data analysis. RESULTS: Based on the results, being married was associated with better SRPH, the net of all confounders. A significant interaction was found between race and marital status on SRPH, suggesting a larger association for Blacks compared to Whites. In race stratified models, marital status was related to better SRPH for Whites and Blacks, but the magnitude of this link was larger for Blacks compared to Whites. CONCLUSION: Overall, marital status was differently linked to SRPM for Whites and Blacks. Accordingly, policymakers should be cautious while not assuming that diverse racial and ethnic groups with similar economic resources have similar health status.

Supplemental material, Supplementary for Lung cancer screening patient–provider discussion: Where do we stand and what are the associated factors? by Hamid Chalian, Pegah Khoshpouri, Arya M Iranmanesh, Joseph G Mammarappallil and Shervin Assari in SAGE Open Medicine

BACKGROUND: Educational attainment and income are central to maintenance of body mass index (BMI), physical activity, and self-rated health (SRH). However, less is known about how social groups differ in the role of educational attainment and income on subsequent changes in these health outcomes. This study compared race/ethnicity by gender groups of older Americans for the effects of baseline educational attainment and income on subsequent changes in BMI, physical activity, and SRH. METHODS: The Health and Retirement Study (HRS) followed 37,495 male and female White and African American people above age 50 for 6 years from 2004 to 2010. This number included 15,581 White women, 12,495 White men, 5,580 African American women, and 3,839 African American men. Physical activity, BMI, and SRH were measured every two years. Multi-group structural equation modeling (latent growth curve modeling) was used to compare race/ethnicity by gender groups for the protective effects of educational attainment and income in 2004 on a decline in physical activity, BMI, and SRH from 2004 to 2010. RESULTS: Major race/ethnicity by gender differences were observed in the effects of baseline educational attainment and income on changes in BMI, physical activity, and SRH. Educational attainment and income showed more salient roles for White men and women than African American men and women. To give some examples, baseline education (years) was associated with changes in physical activity of White women and changes in BMI of White men, while baseline income was associated with changes in SRH of White Women. We did not find evidence suggesting that baseline income fully mediates the effect of baseline educational attainment on health outcomes, as in many instances, educational attainment but not income was associated with health changes over time. CONCLUSION: The intersection of race/ethnicity and gender alters how educational attainment and income protects against subsequent changes in physical activity, BMI, and SRH. Social groups may vary in operant mechanisms by which social determinants of health prevent health decline in the United States.

BACKGROUND. Although socioeconomic position (SEP) is associated with better health, the protective effects of high SEP may be smaller for racial and ethnic minorities than Whites, as explained by Minorities’ Diminished Returns theory. It is still unknown whether the association between SEP and systolic blood pressure (SBP) differs for racial and ethnic groups. The current study racial and ethnic variation in the association between SEP (education attainment and household income) and SBP among American adults. METHODS. The National Health and Nutrition Examination Survey (NHANES; 2005–2006) included 4773 adults 20 years or older. Education attainment and household income were the predictor variables, SBP was the outcome variable, age and gender were the covariates, and race/ethnicity was the effect modifier. Multiple linear regression models were used in the pooled sample and each race/ethnicity. RESULTS. In the pooled sample, higher education attainment and household income were associated with lower SBP, net of race, ethnicity, age, and gender. Race/ethnic stratified linear regression models showed protective effects of education attainment and household income against high SBP for Non-Hispanic Whites, a protective effect of household income for Other Hispanics, and no protective effects of education attainment or household income for other race/ethnic groups. CONCLUSIONS. The health gain that follows SEP (education attainment and household income) are simply larger for the socially and economically privileged group (non-Hispanic Whites) and minimized for racial and ethnic groups. Given that the Minorities’ Diminished Returns exist, policies and solutions that merely focus on reducing the racial gap in SEP may not eliminate the pervasive racial and ethnic gap in health problems including high SBP.

Background: Perceived risk and worries of developing cancer are important constructs for cancer prevention. Many studies have investigated the relationship between health behaviors and subjective risk perception. However, factors correlated with lung cancer risk perception and worries in individuals more susceptible to lung cancer have rarely been investigated. Objective: To determine demographic, social, and behavioral determinants of cancer perceived risk and worries and to explore heterogeneities in these associations by the level of lung cancer risk in a nationally representative sample of American adults. Methods: For this cross-sectional study, data came from the Health Information National Trends Survey (HINTS) 2017, which included a 2277 representative sample of American adults. Smoking status, cancer perceived risk, cancer worries, age, gender, race, education, income, and insurance status were measured. We ran structural equation models (SEMs) for data analysis. Results: &ldquo, Ever smoker&rdquo, status was associated with higher cancer perceived risk (b = 0.25, 95% CI = 0.05&ndash, 0.44, p = 0.013) and worries (b = 0.34, 95% CI = 0.18&ndash, 0.50, p &lt, 0.001), suggesting that &ldquo, ever smokers&rdquo, experience higher levels of cancer perceived risk and worries regarding cancer, compared to &ldquo, never smokers&rdquo, Other factors that correlate with cancer perceived risk and worries were race, age, income, and insurance status. Blacks demonstrated less cancer perceived risk and worry (b = &minus, 0.98, 95% CI = &minus, 1.37&ndash, 0.60, p &lt, 0.001) in both low and high risk lung cancer groups. However, the effects of social determinants (income and insurance status) and age were observed in low but not high risk group. Conclusions: Determinants of cancer perceived risk and worries vary in individuals depending on the level of lung cancer risk. These differences should be considered in clinical practice and policy makings with the goal of improving participation rates in lung cancer screening programs.

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

Background. According to the Minorities&rsquo, Diminished Returns (MDR) theory, the health returns of socioeconomic status (SES) are systemically smaller for Blacks compared to Whites. Less is known, however, about trans-generational aspects of such diminished gains. For example, the differential impact of parental educational attainment on differences in mental well-being between White versus Black college students remains unknown. Aims. With a national scope, this study explored racial differences in the effect of parental educational attainment on the mental well-being of college students in the United States. Methods. The Healthy Mind Study (HMS), 2016&ndash, 2017, is a national telephone survey that included 41,898 college students. The sample was composed of Whites (n = 38,544, 92.0%) and Blacks (n = 3354, 8.0%). The independent variable was highest parental educational attainment. The dependent variable was mental well-being (mentally healthy days in the past month) which was measured using a single item. Age and gender were covariates. Race was the moderator. Logistic regression was used for data analysis. Results. In the pooled sample, high parental educational attainment was associated with better mental wellbeing, independent of race, age, and gender. Race, however, showed a significant interaction with parental educational attainment on students&rsquo, mental wellbeing, indicating a smaller effect of parent education on the mental wellbeing of Black compared to White college students. Conclusions. The returns of parental educational attainment in terms of mental well-being is smaller for Black college students compared to their White counterparts. To minimize the diminished returns of parental education in Black families, policies should go beyond equalizing SES and reduce the structural barriers that are common in the lives of Black families. Policies should also aim to reduce extra costs of upward social mobility, prevent discrimination, and enhance the quality of education for Blacks. As the mechanisms that are involved in MDR are multi-level, multi-level solutions are needed to minimize the racial gaps in gaining mental health benefits from higher socioeconomic levels.

Background: Minorities&rsquo, Diminished Return (MDR) can be defined as smaller health gains from socioeconomic status (SES) indicators, such as education attainment among ethnic minorities compared to the majority group. The current study tested whether income explains why Black and White adults differ in the association between education attainment and self-rated health (SRH). Methods: With a cross-sectional design, this study used data from Cycle 5 of the Health Information National Trends Survey (HINTS), 2017. With a nationally representative sample, the HINTS study generates results that are generalizable to US adults. This study included 2277 adults who were either non-Hispanic White (n = 1868, 82%) or non-Hispanic Black (n = 409, 18%). The independent variable was education attainment. The dependent variable was SRH, measured using a standard single item. Age, gender, and health insurance status were covariates. Ethnicity was the focal moderator. Income was the mediator. A structural equation model (SEM) was applied for data analysis. Results: Overall, higher education attainment was associated with better SRH, net of covariates. However, a significant interaction between ethnicity and education attainment suggested a smaller SRH gain from education for Blacks compared to Whites. This interaction could be explained by Black&ndash, White differences in income. Conclusion: Our study results suggests that labor market preferences may explain smaller effects of education attainment on SRH for Blacks relative to Whites. Given this finding and other studies documenting MDR, policies should reduce labor market discrimination, increasing job opportunities and reducing the racial pay gap for Blacks. Programs should help Blacks compete for prestigious and high-paying jobs.

Although perceived discrimination in Black youth is a risk factor for a wide range of negative mental health outcomes, recent research has suggested some gender differences in these associations. Gender differences in vulnerability to perceived discrimination among Caribbean Black youth is, however, still unknown. The current cross-sectional study investigated gender variations in the association between perceived discrimination and substance use (SU) in a national sample of Caribbean Black youth. Data came from the National Survey of American Life-Adolescents (NSAL-A), 2003&ndash, 2004. This analysis included 360 Caribbean Black youth (165 males and 195 females) who were between 13 and 17 years old. Sociodemographic factors, perceived discrimination, and SU were measured. Logistic regressions were used for data analysis. Among Caribbean Black youth, a positive association was found between perceived discrimination and SU (odds ratio (OR) = 1.15 (95% confidence interval (CI) = 1.02&ndash, 1.29)). A significant interaction was found between gender and perceived discrimination on smoking (OR = 1.23 (95% CI = 1.07&ndash, 1.41)) suggesting that the association between perceived discrimination and smoking is larger for male than female Caribbean Black youth. The interaction between gender and perceived discrimination on SU was not statistically significant (OR = 1.32 (95% CI = 0.94&ndash, 1.86)). While perceived discrimination increases SU in Caribbean Black youth, this effect is stronger for males than females, especially for smoking. While discrimination should be reduced at all levels and for all populations, clinicians may specifically address discrimination for SU prevention and treatment among male Caribbean Black youth.

Background. Community-based studies have documented racial differences in social, psychiatric, and medical determinants of suicidal ideation, however, less is known about racial differences in the profile of suicide attempts in clinical settings. Aim. The current study aimed to compare Blacks and Whites who attempted suicide for demographic factors, socioeconomic status, medical history, psychiatric disorders, and outcomes. Methods. This retrospective study was a retrospective chart review of DataDirect, which is an electronic data repository of the Michigan Health Care System, 2014 to 2017. This analysis included 6147 suicide attempts (5388 Whites and 759 Blacks). Race, sociodemographic factors, medical history, psychiatric disorders, and outcomes were measured. Results. Blacks and Whites with suicide attempt did not differ in age or gender, but varied by insurance type. Blacks were more commonly under Medicare and Medicaid, while Whites were more commonly under private insurance or self-pay (p &lt, 0.05). Blacks with suicide attempt were more likely to be obese, while Whites with suicide attempt were more likely to be underweight. Frequency of psychiatric disorders, including depression, alcohol abuse, drug abuse, and psychosis, were not different between Whites and Blacks with suicide attempt, however, medical conditions showed a different profile across racial groups. When compared to Whites, Blacks had higher prevalence of uncomplicated hypertension, renal failure, chronic obstructive pulmonary disease, coagulopathy, and obesity (p &lt, 0.05 for all comparisons). In contrast, Whites had higher prevalence of other neurological disorders than Blacks. There were no differences in in-patient survival rate between Whites and Blacks who attempted suicide. Conclusion. There are considerable differences between Blacks and Whites with at least one suicide attempt. Although their psychiatric diagnoses seem to be similar, Blacks who have attempted suicide attempt have more medical comorbidities than their White counterparts. Lack of racial disparities in in-patient mortality rate of suicide attempts in the Michigan Health Care System is promising news given the higher physical health needs of Blacks when compared to Whites.

Background: Minorities&rsquo, Diminished Return theory is defined as the relative disadvantage of minority populations compared to Whites regarding health gains that follow socioeconomic status (SES). To test whether Minorities&rsquo, Diminished Return theory holds for unmet dental care needs (DCN), we investigated Black-White differences in the effects of family income on unmet DCN among children. Methods: Data from the National Survey of Children&rsquo, s Health were used. Participants were either White or Black children age 1 to 18. Family income-to-needs ratio was the independent variable. Unmet DCN was the dependent variable. Covariates included age, gender, and parental educational attainment. Race was the focal moderator. We ran logistic regression for data analysis. Results: Higher income-to-needs ratio was associated with lower risk of unmet DCN in the pooled sample. We found an interaction between race and family income-to-needs ratio on unmet DCN, suggesting a stronger protective effect for Whites than Blacks. Conclusion: Minorities&rsquo, Diminished Return also holds for the effects of family income-to-needs ratio on unmet DCN. The relative disadvantage of Blacks compared to Whites in gaining oral health from their SES may reflect structural racism that systemically hinders Black families. There is a need for additional research on specific societal barriers that bound Blacks&rsquo, oral health gain from their SES resources such as income. Policies and programs should also help Black families to leverage their SES resources.

Background: Minorities&rsquo, Diminished Return (MDR) theory suggests that socioeconomic position (SEP) may have a smaller effect on health and well-being of members of the minority than the majority groups. Aim: Built on the MDR theory, this study compared Whites and African Americans for the effects of three family SEP indicators (family type, parental education, and parental employment) during adolescence on subsequent symptoms of anxiety 18 years later during young adulthood. Methods: Flint Adolescents Study (FAS), 1994&ndash, 2012, followed 359 youth (ages 13 to 17, 295 African American and 64 Whites) for 18 years. The independent variables were family type, parental education, and parental employment during adolescence. The dependent variable was subsequent symptoms of anxiety, measured using the Brief Symptom Inventory (BSI), 18 years later. Age and gender were the covariates and race/ethnicity was the focal effect modifier (moderator). Four linear regression models were estimated to investigate the effects of the three family SEP indicators at age 15 on subsequent symptoms of anxiety at age 33 in the pooled sample and also by race/ethnicity. Results: In the pooled sample, having married parents at age 15 was inversely associated with symptoms of anxiety at age 33. We found an interaction between race/ethnicity and family type, indicating a smaller protective effect of having married parents against symptoms of anxiety for African American compared to White participants. The other two SEP indicators did not show any effect and did not interact with race/ethnicity on the outcome. Conclusion: In support of the MDR theory, marital status of parents during adolescence protects White but not African American young adults against anxiety symptoms. Diminished return of SEP is one of many underlying mechanisms involved in shaping racial and ethnic disparities in anxiety, however, that is often overlooked. Future research that examines economic and social policies and programs that can equalize the health gains that follow SEP resources among racial groups would be a useful next step.