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Background: Perceptions of the US healthcare system can impact individuals' healthcare utilization, including vaccination intentions. This study examined the association between perceived racial-ethnic inequities in COVID-19 healthcare and willingness to receive the COVID-19 vaccine. Methods: This study used data from REACH-US, a nationally representative online survey of a large, diverse sample of U.S. adults (N=5145 January 26, 2021-March 3, 2021). Confirmatory factor and regression analyses examined a latent factor of perceived racial-ethnic inequities in COVID-19 healthcare, whether the factor was associated with willingness to receive the COVID-19 vaccine, and whether associations varied across racial-ethnic groups reported as probit estimates (B) and 95% confidence intervals (CIs). Results: Perceived racial-ethnic inequities in COVID-19 healthcare were highest among Black/African American adults (mean latent factor score: 0.65 ± 0.43) and lowest among White adults (mean latent factor score: 0.04 ± 0.67). Black/African American (B = -0.08; 95% CI = -0.19, 0.03) and Native Hawaiian/Pacific Islander (B = -0.08; 95% CI = -0.23, 0.07) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were less willing than participants who perceived lower inequities. In contrast, American Indian/Alaska Native (B = 0.15; 95% CI = -0.01, 0.30), Asian (B = 0.20; 95% CI = 0.08, 0.31), Hispanic/Latino (English language preference) (B = 0.22; 95% CI = 0.01, 0.43), Multiracial (B = 0.23; 95% CI = 0.09, 0.36), and White (B = 0.31; 95% CI = 0.19, 0.43) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were more willing to receive the COVID-19 vaccine than participants perceiving higher inequities. Conclusions: Greater perceived racial-ethnic inequities in COVID-19 healthcare were associated with less willingness to receive the COVID-19 vaccine among Black/African American and Native Hawaiian/Pacific Islander adults. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity research has focused on the prevalence and consequences of multimorbidity in older populations. Less is known about the accumulation of chronic conditions earlier in the life course. Methods: We identified patterns of longitudinal multimorbidity accumulation using 30 years of data from in-person exams, annual follow-ups, and adjudicated end-points among 4,945 participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Chronic conditions included arthritis, asthma, atrial fibrillation, cancer, end stage renal disease, chronic obstructive pulmonary disease, coronary heart disease, diabetes, heart failure, hyperlipidemia, hypertension, and stroke. Trajectory patterns were identified using latent class growth curve models. Results: Mean age (SD) at baseline (1985-6) was 24.9 (3.6), 55% were female, and 51% were Black. The median follow-up was 30 years (interquartile range 25-30). We identified six trajectory classes characterized by when conditions began to accumulate and the rapidity of accumulation: (1) early-fifties, slow, (2) mid-forties, fast, (3) mid-thirties, fast, (4) late-twenties, slow, (5) mid-twenties, slow, and (6) mid-twenties, fast. Compared with participants in the early-fifties, slow trajectory class, participants in mid-twenties, fast were more likely to be female, Black, and currently smoking and had a higher baseline mean waist circumference (83.6 vs. 75.6 cm) and BMI (27.0 vs. 23.4 kg/m2) and lower baseline physical activity (414.1 vs. 442.4 exercise units). Conclusions: A life course approach that recognizes the heterogeneity in patterns of accumulation of chronic conditions from early adulthood into middle age could be helpful for identifying high risk subgroups and developing approaches to delay multimorbidity progression. [ABSTRACT FROM AUTHOR]

This study examines how the intersecting consequences of race-ethnicity, gender, socioeconomics status (SES), and age influence health inequality. We draw on multiple-hierarchy stratification and life course perspectives to address two main research questions. First, does racial-ethnic stratification of health vary by gender and/or SES? More specifically, are the joint health consequences of racial-ethnic, gender, and socioeconomic stratification additive or multiplicative? Second, does this combined inequality in health decrease, remain stable, or increase between middle and late life? We use panel data from the Health and Retirement Study (N = 12,976) to investigate between- and within-group differences in in self-rated health among whites, blacks, and Mexican Americans. Findings indicate that the effects of racial-ethnic, gender, and SES stratification are interactive, resulting in the greatest racial-ethnic inequalities in health among women and those with higher levels of SES. Furthermore, racial-ethnic/gender/SES inequalities in health tend to decline with age. These results are broadly consistent with intersectionality and aging-as-leveler hypotheses.

This study draws on role theory and the life course perspective to examine how sleep health (duration, quality, and latency) is shaped by social role accumulation (number of roles), role repertoires (role combinations), and role contexts among middle-aged adults. We also examine how the relationships between social roles and sleep health are gendered. We use data from the National Longitudinal Survey of Youth 1979 Cohort (N = 7,628). Results show that role accumulation is associated with less sleep and decreased insomnia symptoms, and that role repertoires also impact sleep (e.g., parenthood leads to diminished sleep quantity and quality). There is also evidence that contextual factors related to employment history, marital quality, and parenthood affect sleep health. Furthermore, results reveal that several of the relationships between social roles and sleep are gendered. Taken together, findings demonstrate the utility of examining links between multiple dimensions of social roles and sleep health. [ABSTRACT FROM AUTHOR]

Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories. (Contains 3 tables and 2 figures.)

We explore women's psychological well-being in late midlife in relation to childlessness and timing of entry into motherhood. Using two U.S. surveys, Health and Retirement Study (HRS) (1992) and National Survey of Families and Households (NSFH) (Sweet, Bumpass, & Call, 1988), we assess the well-being of childless women in their 50s compared to mothers with early, delayed, or normatively timed first births. We focus on the cohorts born between 1928 and 1941, who experienced strong normative pressures during the baby boom with regard to marriage and child-bearing. We find few differences among childless women but lower well-being among early mothers, related to singlehood and poorer socioeconomic status. Unmarried mothers are significantly disadvantaged regardless of maternal timing, controlling for socioeconomic status. Current maternal demands are independently related to well-being and help to explain observed differences in family satisfaction. Overall, childlessness and off-time child-bearing are related to midlife well-being through their link with more proximate factors, particularly current marital status, health, and socioeconomic status. The institution of marriage had a power and inevitability in the fifties that it has never had since. You simply didn't ask yourself "if" you wanted marriage and children; the only relevant questions were when and how many? And the answers were, as soon as possible and as many as possible" (Harvey, 1993, p. 69). We explore women's psychological well-being in late midlife in relation to childlessness and timing of entry into motherhood. (Harvey, 1993, p. 69). (Contains 5 tables.)

Objectives. The purpose of this study was to investigate how women's labor force withdrawal behavior varies across race/ethnicity and to identify life course factors that generate these differences. Methods. Using a sample of 7,235 women from the 1992-2004 Health and Retirement Study, we estimated cross-sectional multinomial logit models to explore racial/ethnic differences in labor force status at first interview. We then examined the prospective risk of exiting the labor force via retirement, work disability, or death using discrete-time hazard models. Results. Black and Hispanic women had twice the odds of Whites of being work-disabled at first interview. Whereas younger minorities had lower odds of being retired at first interview, older minorities had higher odds. The prospective results showed that both Blacks and Hispanics had higher risks of work disability but not of retirement or of dying in the labor force. Overall, racial/ethnic differences in mid- and later life work behavior stemmed primarily from disparities in life course capital. Discussion. This study shows that substantial racial/ethnic disparities in labor force exit behavior have already emerged by midlife. It is important to note that distinguishing between alternative pathways out of the labor force demonstrates that work disability is a more common experience for Black and Hispanic women than for Whites. Key Words: Retirement--Gender--Race/ethnicity--Life course--Work disability.

We explore women's psychological well-being in late midlife in relation to childlessness and timing of entry into motherhood. Using two U.S. surveys, Health and Retirement Study (HRS) (1992) and National Survey of Families and Households (NSFH) (Sweet, Bumpass, & Call, 1988), we assess the well-being of childless women in their 50s compared to mothers with early, delayed, or normatively timed first births. We focus on the cohorts born between 1928 and 1941, who experienced strong normative pressures during the baby boom with regard to marriage and child-bearing. We find few differences among childless women but lower well-being among early mothers, related to singlehood and poorer socioeconomic status. Unmarried mothers are significantly disadvantaged regardless of maternal timing, controlling for socioeconomic status. Current maternal demands are independently related to well-being and help to explain observed differences in family satisfaction. Overall, childlessness and off-time child-bearing are related to midlife well-being through their link with more proximate factors, particularly current marital status, health, and socioeconomic status.

Objectives The aim of this evidence-based theoretically informed article was to provide an overview of how and why the COVID-19 outbreak is particularly detrimental for the health of older Black and Latinx adults. Methods We draw upon current events, academic literature, and numerous data sources to illustrate how biopsychosocial factors place older adults at higher risk for COVID-19 relative to younger adults, and how structural racism magnifies these risks for black and Latinx adults across the life course. Results We identify 3 proximate mechanisms through which structural racism operates as a fundamental cause of racial/ethnic inequalities in COVID-19 burden among older adults: (a) risk of exposure, (b) weathering processes, and (c) health care access and quality. Discussion While the ongoing COVID-19 pandemic is an unprecedented crisis, the racial/ethnic health inequalities among older adults it has exposed are longstanding and deeply rooted in structural racism within American society. This knowledge presents both challenges and opportunities for researchers and policymakers as they seek to address the needs of older adults. It is imperative that federal, state, and local governments collect and release comprehensive data on the number of confirmed COVID-19 cases and deaths by race/ethnicity and age to better gauge the impact of the outbreak across minority communities. We conclude with a discussion of incremental steps to be taken to lessen the disproportionate burden of COVID-19 among older Black and Latinx adults, as well as the need for transformative actions that address structural racism in order to achieve population health equity. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the psychosocial mechanisms underlying older Black men's self-rated health, we examined: (a) the individual, cumulative, and collective effects of stressors on health; (b) the direct effects of psychosocial resources on health; and (c) the stress-moderating effects of psychosocial resources. Method: This study is based on a nationally representative sample of Black men aged 51-81 (N = 593) in the Health and Retirement Study (HRS). Ordinary least squares (OLS) regression models of the psychosocial determinants of self-rated health draw on data from the HRS 2010 and 2012 Core datasets and Psychosocial Modules. Results: Each of the six measures of stressors as well as a cumulative measure of stressors are predictive of worse self-rated health. However, when considered collectively, only two stressors (chronic strains and traumatic events) have statistically significant effects. Furthermore, two of the five psychosocial resources examined (mastery and optimism) have statistically significant protective effects, and prayer moderates the harmful effects of traumatic events on self-rated health. Discussion: Conventional measures of stressors and coping resources--originally developed to account for variance in health outcomes among predominantly white samples--may not capture psychosocial factors most salient for older Black men's health. Future research should incorporate psychosocial measures that reflect their unique experiences. [ABSTRACT FROM AUTHOR]

Although older Black women experience disproportionately high rates of morbidity, relatively little is known about the psychosocial mechanisms underlying their health. This study advances the field by drawing on stress processes and intersectionality frameworks to understand the health consequences of psychosocial factors among a nationally representative sample of Black women over the age of 50. We take a broad and systematic approach to analyzing relationships among psychosocial stressors and resources and health among older Black women to address three research questions. First, how do stressors (discrimination, chronic stressors, traumatic events, and financial strains) individually and collectively influence health? Second, are psychosocial resources (social support, mastery, optimism, religiosity, and prayer) protective of health? Third, to what extent do psychosocial resources moderate relationships between stressors and health? To address these questions, we utilize data from the Health and Retirement Survey (HRS) Core Data and Psychosocial Modules (N = 1,263) and nested multivariate regression analyses. We focus on measures of global health and functional health, which have previously established relationships with stress processes. Results highlight the utility of examining the health consequences of stressors collectively rather than individually in order to avoid biased estimates. Findings also indicate that several of the psychosocial resources examined are protective of older Black women's health; we find no evidence that these resources moderate the impacts of stressors on their self-rated health or functional limitations. We conclude by discussing the theoretical, substantive, and methodological implications of these findings. [ABSTRACT FROM AUTHOR]