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Citizenship is both a system of privilege and a source of social identity. This study examines whether there are disparities in psychological distress between citizens and noncitizens, and whether these disparities may be explained by markers of social disadvantage (e.g., poverty, discrimination) or perceptions of success in the United States (i.e., subjective social status). We analyze data from the Asian subsample (n = 2,095) of the National Latino and Asian American Study. The data show that noncitizens report greater psychological distress compared with naturalized citizens and native-born citizens after accounting for sociodemographics (e.g., age, gender, Asian subgroup), socioeconomic characteristics (education, employment, income-to-poverty ratio), immigration (e.g., interview language, years in the United States, acculturative stress), health care visits, and everyday discrimination. Preliminary evidence suggests that subjective social status may explain some of the disparities between naturalized citizen and noncitizen Asian Americans.

OBJECTIVES: We examined the extent to which within-school segregation, as measured by unevenness in the distribution of Black and White adolescents across levels of the English curriculum (advanced placement-international baccalaureate-honors, general, remedial, or no English), was associated with smoking, drinking, and educational aspirations, which previous studies found are related to school racial/ethnic composition. METHODS: We analyzed data from wave 1 of the National Longitudinal Study of Adolescent Health, restricting our sample to non-Hispanic Blacks (n = 2731) and Whites (n = 4158) who from 1994 to 1995 attended high schools that enrolled Black and White students. RESULTS: White female students had higher predicted probabilities of smoking or drinking than did Black female students; the largest differences were in schools with high levels of within-school segregation. Black male students had higher predicted probabilities of high educational aspirations than did White male students in schools with low levels of within-school segregation; this association was attenuated for Black males attending schools with moderate or high levels of within-school segregation. CONCLUSIONS: Our results provide evidence that within-school segregation may influence both students' aspirations and their behaviors. [ABSTRACT FROM AUTHOR]

Recent studies suggest the importance of examining cumulative risk or advantage as potential predictors of health over the life course. Researchers investigating the cumulative health effects of education, however, have mainly conceptualized education in years or degrees, often disregarding educational quality and access to educational opportunities that may place individuals on divergent academic trajectories. We investigate whether educational advantages in youth are associated with an individual's health trajectory. We develop a novel index of educational advantage and employ random-intercept modeling using data from the National Longitudinal Survey of Youth. A widening health disparity was found in adulthood between respondents with greater and those with fewer educational advantages in youth. Furthermore, among respondents with few educational advantages, Blacks experience a greater health burden as they age compared to Whites and Hispanics. These results suggest that differential access to educational advantages during youth may contribute to persisting health disparities in adulthood. [ABSTRACT FROM AUTHOR]

Objectives: We determined if living in historically redlined neighborhoods was associated with level and change in cognitive functioning and if this association differed for Black and White older adults., Methods: We linked the Health and Retirement Study 1998-2018 data to redlining scores from the Historic Redlining Indicator data. Our sample included adults aged 50 years and older (24,230 respondents, 129,618 person-period observations). Using three-level linear mixed models, we estimated the relationship between living in historically redlined neighborhoods on level and change in cognitive functioning for pooled and race-stratified samples., Results: Residents of historically redlined "Declining" and "Hazardous" neighborhoods had lower cognitive functioning scores compared to residents of "Best/Desirable" neighborhoods. Among Black adults, living in "Hazardous" neighborhoods was associated with slower declines in cognitive functioning compared to living in "Best/Desirable" neighborhoods., Discussion: Historical redlining is associated with older adults' cognitive functioning, underscoring the importance of sociohistorical context for the neighborhood-cognition relationship., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Although there is robust evidence that socioeconomic position influences later-life cognitive function, two issues limit knowledge regarding the nature and magnitude of these relationships and potential policy interventions. First, most social science research tends to treat cognition as a unitary concept despite evidence that cognitive outcomes are not interchangeable. Second, most biomedical research focuses exclusively on education, with limited attention to economic resources despite robust social science theoretical and empirical rationales for their role. Relatedly, there has been limited attention to how these relationships may vary across cohorts, even as educational and economic contexts have changed. Using the Health and Retirement Study (N = 36,494), we show that failing to attend to different facets of cognition, socioeconomic resources, and cohort differences leads to underestimates in the magnitude of educational and economic disparities in cognitive function and decline. This has important implications for appropriate policy interventions to address these disparities.

Relatively few neighborhood-focused studies explicitly model the relationship between neighborhood change- i.e., racial change within a neighborhood-and individual mental health, instead focusing on the current composition of the neighborhood or on the outcomes of individuals that switch neighborhood contexts via moves. Further, while neighborhoods and schools are interconnected, researchers tend to focus on only one of these contexts in their work. Combining family and student data from the Panel Study of Income Dynamics (PSID) with multiple waves of neighborhood and school administrative data, our study extends current scholarship in this area by explicitly focusing on the relationship between exposure to neighborhood and school racial change-i.e., change occurring within the neighborhood or school in the prior decade-and the behavior problems of current students. We further analyze how associations vary: 1) by student race; 2) between newcomers to the neighborhood and those that lived in the neighborhood as it underwent demographic change; 3) and in neighborhoods with higher proportions of same-race residents. Our findings suggest that the relationship between local neighborhood contexts and the behavioral problems of children is nuanced and depends on the racial trajectories-change or stability-of neighborhoods, schools, and the interaction of both. Compared to longer-term residents, White newcomers tended to have more behavioral problems across racially changing and stable neighborhoods alike, regardless of the racial trajectories observed in the local school. Our results align with past work documenting the protective effect of same-race peers for Black children. Conversely, we find White students exhibit greater behavioral problems in settings with very high proportions of same-race peers, particularly in neighborhoods and schools that are simultaneously becoming increasingly racially isolated., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Policy Points Education-cognition research overlooks the role of education quality in shaping cognitive function at midlife and older ages, even though quality may be more responsive to federal and state investment in public schooling than attainment. For older US adults who attended school during the early to mid-20th century, the quality of US education improved considerably as federal and state investment increased. Ensuring access to high-quality primary and secondary education may protect against poor cognitive function at midlife and older ages, particularly among Black Americans and persons who complete less education. It may also play an important role in reducing health inequities., Context: Although educational attainment is consistently associated with better cognitive function among older adults, we know little about how education quality is related to cognitive function. This is a key gap in the literature given that the quality of US education improved considerably during the early to mid-20th century as state and federal investment increased. We posit that growing up in states with higher-quality education systems may protect against poor cognitive function, particularly among Black adults and adults who completed fewer years of school., Methods: We used prospective data on cognitive function from the Health and Retirement Study linked to historical data on state investment in public schools, restricting our sample to non-Hispanic White and Black adults born between 1914 and 1959 (19,096 White adults and 4,625 Black adults). Using race-stratified linear mixed models, we considered if state-level education quality was associated with level and decline in cognitive function and if these patterns differed by years of schooling and race., Findings: Residing in states with higher-resourced education systems during childhood was associated with better cognitive function, particularly among those who completed less than 12 years of schooling, regardless of race. For White adults, higher-resourced state education systems were associated with higher scores of total cognitive function and episodic memory, but there were diminishing returns as resources increased to very high levels. For Black adults, the relationship between state education resources and cognitive function varied by age with positive associations in midlife and generally null or negative associations at the oldest ages., Conclusions: Federal and state investment in public schools may provide students with opportunities to develop important cognitive resources during schooling that translate into better cognitive function in later life, especially among marginalized populations., (© 2024 The Author(s). The Milbank Quarterly published by Wiley Periodicals LLC on behalf of The Milbank Memorial Fund.)

Rationale: Black adults experience worse cognitive function than their White peers. Although educational attainment is an important predictor of cognitive function, other aspects of education, including school desegregation, may also shape this relationship. For Black adults who grew up in the U.S. South in the 1950s-1970s, exposure to school desegregation may have altered life course pathways critical for later cognitive function., Objective: We determined if state variation in exposure to school desegregation in the U.S. South was associated with cognitive function at mid-life, if the association varied by race, and if the association remained after adjustment for state-level education quality and respondents' educational attainment., Methods: We linked historical data on state-level school desegregation to the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older. We restricted our sample to Black (n = 1443) and White (n = 1507) adults born between 1948 and 1963 who resided in the U.S. South during primary school. We assessed three cognition outcomes: total cognitive function, episodic memory, and mental status. We estimated race-stratified linear regression models with cluster adjustment and a final model using state fixed effects., Results: Greater exposure to desegregated primary schooling was associated with higher cognitive function and episodic memory among Black but not White adults. Among Black adults, the association between school desegregation and cognitive function and episodic memory remained after adjustment for state-level education quality and educational attainment., Conclusions: Our findings suggest that state-level school desegregation efforts played a consequential role in shaping the cognitive function of Black adults who grew up in the U.S. South., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Federal legislation and judicial intervention led to significant transformation in the U.S. education system during the early to mid-20th century. These changes may differentiate older adults in their experiences of aging, particularly at the intersection of race, gender, and cohort, but are not well documented among current cohorts of older adults. Our study addresses this gap by providing rich, descriptive information on the educational experiences of U.S. adults who attended primary or secondary school between 1915 and 1977. We used data from the Health and Retirement Study (HRS), a nationally representative, prospective study of U.S. adults over age 50 years. The HRS collected information on respondents' schooling history and experiences through a Life History Mail Survey (LHMS). We restricted our sample to age-eligible HRS-LHMS respondents who self-identified as non-Hispanic White or non-Hispanic Black and completed at least 75% of their primary or secondary schooling in the U.S. (n=10,632). Educational experiences, defined as pre-k to post-secondary education, varied across cohort, regardless of race or gender. Greater course offerings, improvements in learning support, and increasing exposure to integrated schools occurred across successive cohorts. We found the highest rates of enrollment in college preparatory curriculum and foreign-language courses as well as diagnosed learning differences in cohorts born after 1948. Among White adults, many of the gender differences in educational experiences documented in the oldest cohort were still found among the most recent cohort. Few gender differences, however, were found for Black adults regardless of cohort. Conversely, most race inequities in educational experiences persisted. Such inequities may be an important source of continued differences in experiences of aging observed across demographic groups.

Racial health inequities persist despite many attempts to correct them. Inadequate comprehension of racism obscures the ordinariness of racism in public health institutions. In addition to applying critical race theory (CRT) to the research and practice of public health, we argue that the struggle for health equity must also apply CRT toward the teaching of public health students. Adhering to conventional approaches in academic public health without grappling with their roots in Whiteness reproduces a public health workforce that is insufficiently equipped to address the complex, systemic issues underlying health inequities. By default, academic public health excludes the perspectives of scholars of color, relies too heavily on theories of individual behavior, and applies top-down teaching methods. To make durable changes, the rising generation of public health scholars and practitioners must understand how health equity fits within broader struggles for racial and social justice. Thus, we critique three responsibilities for teaching about public health: assigning readings, shaping analytical lenses with theories, and modeling change through andragogy. By questioning whose knowledge is legitimized when defining public health needs, whose lenses are used to prioritize solutions, and whose insights drive change, we can train a public health workforce more critical of racism, and more prepared to deal with the enduring reality of racial relations.

In the U.S., Black adults consistently have higher allostatic load - an indicator of physiological dysregulation - than White adults. Education is considered a likely mechanism given racial differences in attainment, but evidence is mixed. This may be due, in part, to data limitations that have made it difficult for scholars to account for the structurally rooted systemic racism that shaped the U.S. education system and led to large racial inequities in school term length and school attendance among older adults who grew up in the Jim Crow South. Our study addresses this limitation by linking historical data on Black and White segregated school systems in the U.S. South from 1919 to 1954 to the Health and Retirement Study (HRS) to determine if a new measure of educational attainment that accounts for structural racism that led to differences in the number of school days attended by Black and White students across years and states better explains Black-White inequities in allostatic load among older adults who attended school during Jim Crow. We restrict our sample to HRS respondents racialized as White or Black, who resided in the South when they were school-aged, completed primary/secondary school between 1919 and 1954, and provided a measure of allostatic load (n = 1932). We find that our new measure of schooling - duration in school - reduced the Black-White inequity in allostatic load more so than self-reported years of schooling whether we measured allostatic load continuously (34% vs 16%) or categorically (45% vs 20%). Our findings highlight the importance of identifying and using historically informed measures of schooling that account for structurally rooted systemic racism when trying to understand how education shapes the health of individuals racialized as Black in the United States., Competing Interests: No financial or personal interests to declare., (© 2022 The Authors.)

Objectives: Although education is a key determinant of cognitive function, its role in determining Black-White disparities in cognitive function is unclear. This may be due, in part, to data limitations that have made it difficult to account for systemic educational inequities in the Jim Crow South experienced by older cohorts, including differences in the number of days Black students attended school compared to their White counterparts or Black peers in better-funded southern states. We determine if accounting for differential rates of school attendance across race, years, and states in the Jim Crow South better illuminates Black-White disparities in trajectories of cognitive function., Methods: We linked historical state-level data on school attendance from the 1919/1920 to 1953/1954 Biennial Surveys of Education to the Health and Retirement Study, a nationally representative, longitudinal study of U.S. adults older than age 50. We restricted our sample to Black and White older adults who attended school in the Jim Crow South and began primary school in/after 1919/1920 and completed primary/secondary school by 1953/1954 (n = 4,343). We used linear mixed models to estimate trajectories of total cognitive function, episodic memory, and working memory., Results: Self-reported years of schooling explained 28%-33% of the Black-White disparity in level of cognitive function, episodic memory, and working memory. Duration of school, a measure that accounted for differential rates of school attendance, explained 41%-55% of the Black-White disparity in these outcomes., Discussion: Our study highlights the importance of using a more refined measure of schooling for understanding the education-cognitive health relationship., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Student loan debt has become common for young adults in the U.S. and is correlated with poor physical and mental health. It is unclear how the accumulation or repayment of student debt is associated with longer-term cardiovascular risks and chronic inflammation., Methods: Nationally representative data collected between 1994 and 2018 from >4,000 participants of a U.S. cohort study were analyzed in 2021 to assess the associations among change in student debt between young adulthood and early mid-life, 30-year Framingham cardiovascular disease risk scores, and C-reactive protein levels., Results: Ordinary least squares regression revealed higher cardiovascular disease and C-reactive protein risks among those in households who became indebted or were consistently in debt between young adulthood and early mid-life than among those in households who were either never in debt or repaid their loans. This pattern persisted after adjustments for degree completion, socioeconomic measures, and other sources of debt., Conclusions: These findings provide a benchmark for widening health inequalities among a cohort bearing more student debt than any other in U.S., History: As student debt accumulates, within-cohort disparities in cardiovascular disease and related morbidities may undermine the health benefits of postsecondary education., (Copyright © 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Black adults face a substantially higher risk for dementia in later life compared to their White peers. Given the critical role of educational attainment and cognitive function in later life dementia risk, this paper aims to determine if early educational experiences and educational attainment are differentially related to trajectories of cognitive status across race and if this further varies by education cohort. We use data from the Life History Mail Survey (LHMS) and prospective data on cognition from the Health and Retirement Study (HRS). We restrict our sample to Black and White US-born adults who provided at least one measure of cognitive status from 1995/6-2016. We find evidence of Black-White differences in the association between educational experiences and level of cognitive function, episodic memory, and working memory, but little evidence of Black-White differences in these associations with decline. Having a learning problem was associated with lower levels of cognitive function, episodic memory, and working memory for White and Black older adults, but was more strongly related to these outcomes among Black older adults. Further, the Black-White difference in this association was generally found in older cohorts that completed schooling after enactment of federal policies that improved educational resources for children with learning disabilities. Attending racially discordant schools was positively associated with level of these cognitive outcomes for Black older adults but not for White older adults. We also find that the educational gradient in level of cognitive function was larger for Black compared to White older adults in older cohorts not benefiting from the Brown v Board of Education decision but was similar for Black and White older adults attending school in the post- Brown era., (© 2022 The Author(s).)

Although recent studies report a decline in dementia prevalence among U.S. older adults, national trends may mask subnational variation, particularly given large health and social inequalities linked to geography. To address this gap, we determined if there was subnational variation in reported national dementia trends and if region-specific trends were explained by sociodemographic and health characteristics. Data come from the 2000 (n = 10,447) and 2012 (10,426) waves of the Health and Retirement Study. We used validated methods for dementia classification using proxy and self-respondents. Logistic regression models, adjusted for within-person clustering over time, estimated trends in dementia prevalence by region and census division. We found subnational variation in dementia prevalence in both 2000 and 2012, as well as in change in dementia prevalence during this period. In 2000, dementia prevalence was lowest in the West (8.6%), higher in the Midwest (10.0%) and Northeast (11.1%), and highest in the South (14.6%). Dementia prevalence declined over time across all regions of the U.S. from 2000 to 2012 but remained highest in the South (10.7%) compared to the other regions (7.0-7.8%). Despite downward trends in dementia across the U.S., the prevalence of dementia in the South in 2012 approximated levels found in other regions in 2000. There was relatively less change over time in the West compared to other regions, but dementia prevalence was already quite low in the West in 2000. Within region, trends in dementia prevalence between 2000 and 2012 also varied slightly across census divisions. Subnational variation in changes in dementia prevalence were largely explained by education and health status. Variation in baseline prevalence, as well as differential rates of change, highlight the importance of examining subnational variation in dementia trends., Competing Interests: None of the authors have any conflicts of interest to declare., (© 2022 The Authors.)

Objectives: This article focuses on the older Latino undocumented population and anticipates how their current demographic characteristics and health insurance coverage might affect future population size and health insurance trends., Methods: We use the 2013-2018 American Community Survey as a baseline to project growth in the Latino 55 and older undocumented population over the next 20 years. We use the cohort component method to estimate population size across different migration scenarios and distinguish between aging in place and new immigration. We also examine contemporary health insurance coverage and chronic health conditions among 55 and older undocumented Latinos from the 2003-2014 California Health Interview Survey. We then project health insurance rates in 2038 among Latino immigrants under different migration and policy scenarios., Results: If current mortality, migration, and policy trends continue, projections estimate that 40% of undocumented Latino immigrants will be 55 years or older by 2038-nearly all of whom will have aged in place. Currently, 40% of older Latino undocumented immigrants do not have insurance. Without policies that increase access to insurance, projections estimate that the share who are uninsured among all older Latinos immigrants will rise from 15% to 21%, and the share who is both uninsured and living with a chronic health condition will rise from 5% to 9%., Discussion: Without access to health care, older undocumented immigrants may experience delayed care and more severe morbidity. Our projections highlight the need to develop and enact policies that can address impending health access concerns for an increasingly older undocumented Latino population., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To investigate the association between religious involvement and cognitive functioning at the intersections of race-ethnicity and gender among midlife and older adults, and to determine if psychosocial factors help explain this relationship., Method: The sample included 14,037 adults aged 50+ from the Health and Retirement Study (HRS). We utilized measures from the HRS 2010 and 2012 Core interviews and Leave-Behind questionnaires and estimated our models using linear regression., Results: Compared to individuals who frequently attended religious services, infrequent religious service attendance was related to poorer cognitive functioning. Religiosity was inversely associated with cognitive functioning at baseline, but the relationship varied by race/gender subgroup. Greater religiosity was associated with better cognitive functioning among Black women, but lower cognitive functioning among White men and women. Psychosocial factors did little to explain the inverse association between religiosity and cognitive functioning., Discussion: Results suggest the association between religious involvement and cognitive functioning is varied and complex, and largely dependent on important social identities. The findings have important implications for investigating health-protective factors, like religious involvement, using an intersectional perspective., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Air pollution is linked to worse cognitive function in older adults, but whether differences in this relationship exist by education, a key risk factor for cognitive decline, remains unknown., Objective: To determine if the association between fine particulate matter air pollution (PM2.5) and incident cognitive impairment varies by level of education in two cohorts assessed a decade apart., Methods: We used data on adults ages 60 and older from the nationally representative Health and Retirement Study (HRS) linked with tract-level annual average PM2.5. We used mixed-effects logistic regression models to examine education differences in the association between PM2.5 and incident cognitive impairment in two cohorts: 2004 (n = 9,970) and 2014 (n = 9,185). Cognitive impairment was determined with tests of memory and processing speed for self-respondents and proxy and interviewer assessments of cognitive functioning in non-self-respondents., Results: PM2.5 was unrelated to incident cognitive impairment among those with 13 or more years of education, but the probability of impairment increased with greater concentrations of PM2.5 among those with 8 or fewer years of education. The interaction between education and PM2.5 was only found in 2004, possibly because PM2.5 concentrations were much lower in 2014., Conclusion: Education is a key determinant of cognitive decline and impairment, and in higher pollution contexts may serve as a protective factor against the harms of air pollution on the aging brain. Additionally, because air pollution is ubiquitous, and particularly harmful to vulnerable populations, even small improvements in air quality may have large impacts on population health.

At the population level, those with more education tend to report better sleep, mirroring the education gradient found in other health outcomes. But research has shown that higher educational attainment does not always confer the same health benefits for Non-Hispanic Black (Black) and Hispanic adults as it does for Non-Hispanic White (White) adults. It is therefore possible that the educational gradient in sleep varies across racial/ethnic groups in the United States. Using the 2004-2018 National Health Interview Survey (N = 356,048), we examined differences in self-reported sleep duration and sleep quality by level of educational attainment and race/ethnicity. Utilizing multinomial (sleep duration) and negative binomial (times in the past week with difficulty falling asleep and staying asleep) regression models, we found that, compared to their less educated counterparts, college or more educated Whites were more likely to report ideal sleep compared to short or long sleep, and also reported fewer times with difficulty falling or staying asleep. The education-sleep association was generally reversed for Black and Hispanic adults, with the worst sleep being reported by those with college-level education. These patterns remained after adjusting for health behaviors, health outcomes, and socioeconomic status. Our study suggests that education does not yield the same protective benefit for sleep among Black and Hispanic adults as it does for White adults, and that highly educated Black and Hispanic adults in particular experience a sleep disadvantage. The differential education gradient in sleep may, therefore, be an important factor underlying current racial and ethnic health disparities., Competing Interests: We have no conflicts of interest to report., (© 2020 The Author(s).)

Objectives: More parents are borrowing to help their children pay for college. These loans may be a source of financial stress and worry, which could influence parents' mental health. We determine whether child-related educational debt is associated with worse mental health among parents and if fathers are more sensitive to this debt than mothers, given potential gender differences in financial decision-making and relationships with adult children., Method: Data come from the National Longitudinal Survey of Youth 1979, a nationally representative sample of persons born between 1957 and 1964. We used the Center for Epidemiologic Studies Depression Scale and the Short Form-12 Mental Health Component Score to assess mental health. We restricted our sample to parents who had at least one biological child attend college and who were interviewed at age 50, when mental health was assessed (n = 3,545)., Results: Among fathers, having any child-related educational debt versus none was associated with fewer depressive symptoms, but having greater amounts of child-related educational debt was associated with more depressive symptoms and worse mental health. No relationship was found for mothers., Discussion: Our findings indicate that the student debt crisis may also have mental health implications for aging parents, particularly for fathers., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Educational attainment is often considered the most important protective factor against cognitive impairment and dementia, yet significant variation in early educational experiences exists among midlife and older US adults. We used prospective data from the Health and Retirement Study (HRS) along with information on respondents' early educational experiences collected in the 2015 and 2017 HRS Life History Mail Survey to examine whether school context, educational content, and academic ability were associated with trajectories of cognitive functioning and whether educational attainment explains this relationship. We restricted our sample to age-eligible HRS Life History Mail Survey respondents who provided data on cognitive functioning at least once during 1998-2014 and attended primary school or higher (n = 9,565 respondents providing 62,037 person-period observations). Estimates from linear mixed models revealed that school context, educational content, and academic ability were significantly associated with level of cognitive functioning but not rate of cognitive decline. Educational attainment explained 9%-55% of the association between these early educational experiences and level of cognitive functioning; however, all relationships remained statistically significant. Our results suggest that educational experiences that span childhood and adolescence are independently related to level of cognitive functioning decades later., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: To examine associations between socioeconomic status and two forms of social capital, namely, neighborhood and network measures, and how these distinct forms of capital are associated with body mass index (BMI) among Black residents of low-income communities., Design: Respondent-driven sampling was used to engage residents in a household survey to collect data on the respondents' personal network, perceptions about their neighborhood environment, and health., Setting: Eight special emphasis neighborhoods in Greenville, South Carolina., Participants: N = 337 black/African American older adults, nearly half of whom have a household income of less than $15 000 and a high school education, were included., Measures: Neighborhood capital was assessed via three scales on social cohesion, collective efficacy, and social support from neighbors. Network capital was calculated via a position generator, common in egocentric network surveys. Body mass index was calculated with self-reported height and weight., Analysis: Multilevel linear regression models were used to examine the association between neighborhood and network capital and obesity among respondents within sampling chains., Results: Higher household income was associated with greater neighborhood capital, whereas higher educational attainment was associated with greater network capital. Social cohesion was negatively associated with BMI ( b = -1.25, 95% confidence interval [CI]: -2.39 to -0.11); network diversity was positively associated with BMI ( b = 0.31, 95% CI: 0.08 to 0.55)., Conclusion: The findings shed light on how social capital may be patterned by socioeconomic status and, further, how distinct forms of capital may be differentially associated with health among black Americans.

Background: Personal (i.e. egocentric) network characteristics are associated with health outcomes, including overweight and obesity. Previous research suggests educational attainment may interact with network characteristics to buffer these relationships. Limited research has examined the personal network characteristics of Black Americans, who have increased risk of overweight and obesity. The purpose of the current study was to examine associations between network characteristics and body mass index (BMI), and whether educational attainment modified these associations among Black Americans., Methods: In 2014, using respondent-driven sampling, we recruited 430 adult residents of eight low-income neighborhoods in Greenville, SC. Self-administered questionnaires assessed structural and compositional characteristics (i.e. size, density) of respondents' personal networks, socio-demographic characteristics, and health-related behaviors and conditions. Multilevel regression models with robust sandwich estimation accounted for clustering within respondent chains., Results: Among Black adults overall, network density-the number of connections among network members-was positively associated with BMI. Higher education moderated this relationship; among Black adults with a college degree, higher network density was inversely associated with BMI., Conclusions: Our data suggest low educational attainment may reflect more homogenous and less resourceful networks. Multiple pathways are discussed for how education interacts with network density on BMI among Black Americans., (© The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Study Objectives: To document trends in self-reported sleep duration for the noninstitutionalized U.S. civilian population from 2004 to 2017 and examine how sleep trends vary by race/ethnicity., Methods: We use data from the National Health Interview Survey (NHIS) for U.S. noninstitutionalized adults aged 18-84 from 2004 to 2017 (N = 398 382). NHIS respondents were asked how much they slept in a 24-hour period on average, which we categorized as ≤6 hr (short sleep), 7-8 hr (adequate sleep), and ≥9 hr (long sleep). We used multinomial logistic regression models to examine trends in self-reported sleep duration and assess race/ethnic differences in these trends. Our models statistically adjusted for demographic, socioeconomic, familial, behavioral, and health covariates., Results: The prevalence of short sleep duration was relatively stable from 2004 to 2012. However, results from multinomial logistic regression models indicated that there was an increasing trend toward short sleep beginning in 2013 (b: 0.09, 95% CI: 0.05-0.14) that continued through 2017 (b: 0.18, 95% CI: 0.13-0.23). This trend was significantly more pronounced among Hispanics and non-Hispanic blacks, which resulted in widening racial/ethnic differences in reports of short sleep., Conclusions: Recent increases in reports of short sleep are concerning as short sleep has been linked with a number of adverse health outcomes in the population. Moreover, growing race/ethnic disparities in short sleep may have consequences for racial and ethnic health disparities.

We examined the relationship between two forms of ethnic discrimination-interpersonal and institutional-and smoking outcomes among Arab men in Israel, and whether social support buffered these associations. We used cross-sectional data of adult Arab men, current or former smokers (n = 954). Mixed-effects regression models estimated the association between discrimination and smoking status, and nicotine dependence among current smokers. Interpersonal discrimination was associated with higher likelihood of being a current smoker compared to a former smoker, whereas institutional group discrimination was not. Social support moderated the ethnic discrimination-nicotine dependence link. Among men with low social support, greater interpersonal discrimination was associated with greater nicotine dependence. Similarly, among smokers with high institutional group discrimination, those with high social support reported lower nicotine dependence compared to those with low social support. Ethnic discrimination should be considered in efforts to improve smoking outcomes among Arab male smokers in Israel.

An increasing number of U.S. adults are progressing through college in decidedly more complex ways. Little is known, however, about how this growing heterogeneity may be associated with the health behaviors and ultimately health of young adults. Using a life course perspective, we investigate whether and why different educational pathways - that is, variation in when people attend and complete school - are associated with daily smoking and binge drinking among U.S. young adults. We use 14 waves (1997-2011) of data from the National Longitudinal Survey of Youth 1997 cohort (n=7,359) that enable us to identify the most common educational pathways, as well as their association with young adult health behaviors. Bachelor's degree recipients who enrolled immediately after high school but did not attain their degree within 4 years were more likely to smoke daily in early adulthood (i.e., ages 26 to 32) than those who enrolled in college immediately after high school and attained a bachelor's degree within 4 years. Conversely, bachelor's degree recipients who delayed college enrollment were less likely to binge drink in early adulthood than individuals who enrolled in college immediately after high school and attained a bachelor's degree within 4 years. Marital status and household income in young adulthood accounted for some of the relationships between educational pathways and health behavior. These findings highlight the complexity of education's relationship to health behavior and strongly suggest that heterogeneity in educational pathways should be explicitly examined in population health research. Word Count: 241.

Context: A woman's happiness about a pregnancy and birth has implications for her child's health and her own well-being. Sexual orientation and, particularly, the extent of concordance across its dimensions (sexual identity, behavior and attraction) may be related to happiness about these events, but research on this relationship has been lacking., Methods: Data on 5,744 pregnancies ending in births among women aged 15-44 in three waves of the National Survey of Family Growth (2006-2015) were examined. Weighted linear regression models examined the relationship between sexual orientation concordance and women's happiness about a birth. Analyses also explored whether birth intention and male partnership characteristics mediated the relationship, and whether it varied by intention status., Results: Women who identified as heterosexual but reported same-sex attraction or behavior (categorized as "heterosexual-identified discordant") were less happy about their births than were women who were exclusively heterosexual (or "heterosexual-identified concordant"). The difference was more than half a point on a scale of 0-10 (coefficient, -0.7). This association was partially explained by the fact that births were less likely to be intended, and that relationships with male partners were less favorable for births, among discordant than among concordant women. Moreover, the happiness gap between concordant and discordant women was larger when births were unwanted (predicted score, 4.9 vs. 4.1) than when they were intended (9.3 vs. 9.1)., Conclusions: To help ensure optimal reproductive health care for all women, research should explore whether providers take into account all dimensions of individuals' sexual orientation., (Copyright © 2017 by the Guttmacher Institute.)

Although immigrants are healthier than non-immigrants on numerous outcomes, the reverse appears to be true with regards to food insecurity. Most studies ignore heterogeneity in the risk for food insecurity within immigration status and by ethnicity, even though significant variation likely exists. We consider how immigration status and ethnicity are related to trends in food insecurity among Latinos and Asians in California from 2001 through 2011. Data come from the 2001 to 2011 restricted California Health Interview Survey (n=245,679). We categorized Latinos and Asians as US-born, naturalized/legal permanent residents (naturalized/LPR), and non-LPRs (students, temporary workers, refugees, and undocumented persons). Multivariable weighted logistic regression analyses assessed temporal trends over the 10-year period after adjustment for demographics, socioeconomic characteristics, and program participation. Across this period, US-born Asians reported similar levels of food insecurity as US-born Whites. Conversely, Latinos, regardless of immigration status or nativity, and Asian immigrants (i.e., naturalized/LPR and non-LPR) reported greater food insecurity than US-born Whites. Further, from 2001 through 2009, non-LPR Latinos reported higher risk of food insecurity than naturalized/LPR Latinos. Thus, food insecurity differs between ethnic groups, but also differs within ethnic group by immigration status. Efforts to reduce food insecurity should consider the additional barriers to access that are faced by immigrants, particularly those without legal permanent residency., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: Discussions of student debt often overlook the debt parents take on to pay for their children's education. We identify characteristics of parents with child-related educational debt among the late baby boom cohort., Method: Data come from the National Longitudinal Survey of Youth 1979, a nationally representative sample of individuals born between 1957 and 1964. We restrict our sample to parents who had any children aged ≥17 and answered questions on educational debt during midlife (n = 6,562). Craggit models estimated (a) having any child-related educational debt and (b) the amount of debt owed among debtors., Results: Black parents and parents with more education, higher income, and higher net worth were more likely to report child-related educational debt than White parents and parents with no degree, low-income, or negative net worth. Among debtors, high-income parents had more debt than low-income parents., Discussion: Our findings suggest concerns about the student debt crisis should extend to aging parents., (© The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Gender and racial/ethnic disparities in sleep duration are well documented among the U.S. adult population, but we know little about how these disparities are shaped during the early course of adult life, a period marked by substantial changes in social roles that can influence time for sleep., Methods: Prospective data was used from the National Longitudinal Survey of Youth 1997 (NLSY97), a U.S.-based representative sample of persons born between 1980 and 1984, who were first interviewed in 1997. Sleep duration was assessed in 2002, 2007/2008, 2009, 2010, and 2011. Random-coefficient models were estimated to examine gender and racial/ethnic disparities in trajectories of sleep duration across early adulthood as a function of educational experiences, employment, and family relationships., Results: Sleep duration declined during early adulthood. Women reported shorter sleep than men from age 18 to 22, but slept longer than men by age 28. Black Young adults reported sleep durations similar to those of White young adults until age 24, after which blacks slept less than whites. Educational experiences and employment characteristics reduced gender and racial/ethnic disparities, but family relationships exacerbated them., Conclusion: This study is the first to establish the emergence of gender and racial/ethnic disparities in sleep duration during early adulthood., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: We examine the association between the poverty histories of neighbourhoods and three indicators of psychosocial well-being-depressive symptoms, sense of control and number of stressors-in an observational study of mothers of young children in California. We also consider if length of residence in a neighbourhood moderates the association between neighbourhood poverty history and psychosocial well-being., Methods: Data come from the Geographic Research on Well-being (GROW) Study, a subsample of mothers who completed the population-based California Maternal and Infant Health Assessment in 2003-2007 and were reinterviewed in 2012-2013. Poverty histories of neighbourhoods were constructed using the Neighbourhood Change Database (1970-2000) and American Community Survey (2005-2009). The analytic sample included 2726 women from GROW residing in 1906 census tracts., Results: Adjusting for individual socioeconomic and demographic characteristics, women living in neighbourhoods where poverty decreased over the 40-year period had lower odds of depressive symptoms and a greater sense of control than women living in long-term, low-poverty neighbourhoods. Women living in long-term high-poverty neighbourhoods or in neighbourhoods where poverty increased over the 40-year period reported lower sense of control than women living in long-term, low-poverty neighbourhoods and these effects were modified by length of time living in the neighbourhood. No significant effects of neighbourhood poverty histories were found for number of stressors., Conclusions: Policies aimed at reducing neighbourhood poverty may improve mothers' psychosocial well-being., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objectives: To date, no studies have investigated whether sexual minority women (SMW) are more likely to experience unintended pregnancies compared with their heterosexual peers. The aim of this study was to explore whether adult SMW were more likely to have unintended pregnancies compared with heterosexual women, to examine the role of identity-attraction congruence in unintended pregnancy risk, and to evaluate possible mediators., Methods: Data on pregnancies to women ages 18 to 44 were drawn from the 2006 through 2013 National Survey of Family Growth (n = 25,403). Weighted logistic regression models estimated the likelihood of reporting an unintended (rather than intended) pregnancy by identity-attraction congruence and the extent to which this association was mediated by sexual experiences with men, including age at first sex and number of sexual partners. Supplementary analyses addressed the issue of abortion underreporting., Results: Pregnancies to SMW were more likely to be unintended compared with pregnancies to heterosexual women (adjusted odds ratio, 1.26; 95% confidence interval, 1.08-1.46). This was driven by the elevated risk experienced by heterosexual-identified women with same-sex attractions, specifically (adjusted odds ratio, 1.28; 95% confidence interval, 1.08-1.51). Greater unintended pregnancy risk among these women was mediated by a greater number of male sex partners compared with heterosexual women., Conclusions: Unintended pregnancy risk among SMW has historically received little attention from scholars and clinicians. Future research should explore the specific conditions that put heterosexual-identified women with same sex attractions at increased risk for unintended pregnancy. Clinicians should consider these dynamics when screening patients for contraceptive counseling., (Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Objective: To examine whether socioeconomic and health-related factors explain ethnic disparities in the onset and progression of functional limitations among middle-aged and older Israeli adults., Method: We used data from Waves I-III of the Survey of Health, Aging and Retirement in Europe in Israel. Logistic and multinomial regression models were estimated to examine the association between ethnicity and transitions in functional status (onset versus progression) from respondents' baseline interview (Wave I or II) to their follow-up interview (Wave II or III)., Results: Compared to veteran Jews, Arabs and Jewish immigrants from the former Soviet Union were more likely to experience an onset of functional limitations. Arabs were also more likely to experience worsening functional limitations by follow-up. Education and health-related factors attenuated some of the ethnic disparities in onset and progression of functional limitations., Conclusions: Our findings suggest the importance of moving beyond traditional indicators of socioeconomic status and health-related pathways to fully understand the underlying factors that predict ethnic disparities in the onset and progression of functional limitations in Israel., (© The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

We examine four life course models as they relate to adolescent SES, adult SES, and cardiovascular risk--the sensitive period, pathways, accumulation, and social mobility models. Accounting for race/ethnic and gender differences in life course processes, we analyzed Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of individuals enrolled in grades 7-12 when they were first interviewed in 1994/5. We restricted our sample to whites, blacks, and Latinos who were interviewed in Waves I and IV and provided biomarker data (n = 11,397). The cardiovascular risk score at Wave IV combined waist circumference, blood pressure, hemoglobin A1c, and C-reactive protein. We found evidence for each of the four life course models for white women, whereas the sensitive period was indicated for white men. Upward mobility was also associated with higher CVD risk among white men as compared to those who were socio-economically advantaged at both time points. The pathway model was significant for Latino women. No life course models were significant for black men or women or Latino men. Our findings demonstrate the importance of applying an intersectional lens to understanding CVD risk over the life course., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Student loans are the second largest source of personal debt in the USA and may represent an important source of financial strain for many young adults. Little attention has been paid to whether debt is associated with sleep duration, an important health-promoting behaviour. We determine if student loans are associated with sleep duration. Since black young adults are more likely to have student debt and sleep less, we also consider whether this association varies by race., Methods: Data come from the US National Longitudinal Survey of Youth 1997. The main analytic sample includes 4714 respondents who were ever enrolled in college and who reported on sleep duration in 2010. Most respondents had completed their college education by 2010, when respondents were 25 to 31 years old. Multivariable linear regression models assessed the cross-sectional association between student loans accumulated over the course of college and sleep duration in 2010, as well as between student debt at age 25 and sleep duration in 2010., Results: Black young adults with greater amounts of student loans or more student debt reported shorter sleep duration, controlling for occupation, hours worked, household income, parental net worth, marital status, number of children in the household and other sociodemographic and health indicators. There was no association between student loans or debt with sleep for white or latino adults and other racial/ethnic groups., Conclusions: Student loans may contribute to racial inequities in sleep duration. Our findings also suggest that the student debt crisis may have important implications for individuals' sleep, specifically and public health, more broadly., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: To date there is limited published evidence on the efficacy of tobacco control mass media campaigns in China. This study aimed to evaluate the impact of a mass media campaign 'Giving Cigarettes is Giving Harm' (GCGH) on Chinese smokers' knowledge of smoking-related harms and attitudes towards cigarette gifts., Methods: Population-based, representative data were analysed from a longitudinal cohort of 3709 adult smokers who participated in the International Tobacco Control (ITC) China Survey conducted in six Chinese cities before and after the campaign. Logistic regression models were estimated to examine associations between campaign exposure and attitudes towards cigarette gifts measured post-campaign. Poisson regression models were estimated to assess the effects of campaign exposure on post-campaign knowledge, adjusting for pre-campaign knowledge., Findings: Fourteen percent (n=335) of participants recalled the campaign within the cities where the GCGH campaign was implemented. Participants in the intervention cities who recalled the campaign were more likely to disagree that cigarettes are good gifts (71% vs 58%, p<0.01) and had greater levels of campaign-targeted knowledge than those who did not recall the campaign (mean=1.97 vs 1.62, p<0.01). Disagreeing that cigarettes are good gifts was higher in intervention cities than in control cities. Changes in campaign-targeted knowledge were similar in both cities, perhaps due to a secular trend, low campaign recall or contamination issues., Conclusions: These findings suggest that the GCGH campaign increased knowledge of smoking harms, which could promote downstream cessation. This study provides evidence to support future campaign development to effectively fight the tobacco epidemic in China., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: We evaluated the contributions of teen alcohol use to the formation and continuation of new and existing friendships while in turn estimating the influence of friend drinking on individuals' regular use and heavy drinking., Method: Longitudinal network analysis was used to assess the mutual influences between teen drinking and social networks among adolescents in two large Add Health schools where full network data was collected three times. Friendship processes were disaggregated into the formation of new friendships and the continuation of existing friendships in a joint model isolating friendship selection and friend influences., Results: Friends have a modest influence on one another when selection is controlled. Selection is more complicated than prior studies suggest, and is only related to new friendships and not their duration in the largest school. Alcohol use predicts decreasing popularity in some cases, and popularity does not predict alcohol consumption., Conclusion: Intervention efforts should continue pursuing strategies that mitigate negative peer influences. The development of socializing opportunities that facilitate relationship opportunities to select on healthy behaviors also appears promising. Future work preventing teen substance use should incorporate longitudinal network assessments to determine whether programs promote protective peer relationships in addition to how treatment effects diffuse through social networks.

Objectives: We examined associations between sexual orientation and pregnancy risk among sexually experienced New York City high-school students., Methods: We analyzed data from 2005, 2007, and 2009 New York City Youth Risk Behavior Surveys. We excluded students who had never engaged in sexual intercourse, only had same-gender sexual partners, or had missing data on variables of interest, resulting in a final sample of 4892 female and 4811 male students. We employed multivariable logistic regression to examine pregnancy risk by sexual orientation, measured as self-reported sexual identity and gender of sexual partners, with adjustment for demographics and sexual behaviors. We stratified analyses by gender., Results: Overall, 14.3% of female and 10.8% of male students had experienced a pregnancy. Students who identified as gay, lesbian, or bisexual or reported both male and female sexual partners had higher odds of pregnancy than heterosexual students or students who only had opposite-gender sexual partners. Sexual behaviors accounted for higher odds of pregnancy among female, but only partially accounted for higher odds of pregnancy involvement among male, sexual-minority students., Conclusions: Sexual orientation should be considered in future adolescent pregnancy-prevention efforts, including the design of pregnancy-prevention interventions.

Student loans are increasingly important and commonplace, especially among recent cohorts of young adults in the United States. These loans facilitate the acquisition of human capital in the form of education, but may also lead to stress and worries related to repayment. This study investigated two questions: 1) what is the association between the cumulative amount of student loans borrowed over the course of schooling and psychological functioning when individuals are 25-31 years old; and 2) what is the association between annual student loan borrowing and psychological functioning among currently enrolled college students? We also examined whether these relationships varied by parental wealth, college enrollment history (e.g. 2-year versus 4-year college), and educational attainment (for cumulative student loans only). We analyzed data from the National Longitudinal Survey of Youth 1997 (NLSY97), a nationally representative sample of young adults in the United States. Analyses employed multivariate linear regression and within-person fixed-effects models. Student loans were associated with poorer psychological functioning, adjusting for covariates, in both the multivariate linear regression and the within-person fixed effects models. This association varied by level of parental wealth in the multivariate linear regression models only, and did not vary by college enrollment history or educational attainment. The present findings raise novel questions for further research regarding student loan debt and the possible spillover effects on other life circumstances, such as occupational trajectories and health inequities. The study of student loans is even more timely and significant given the ongoing rise in the costs of higher education., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Researchers know relatively little about the educational attainment of sexual minorities, despite the fact that educational attainment is consistently associated with a range of social, economic, and health outcomes. We examined whether sexual attraction in adolescence and early adulthood was associated with educational attainment in early adulthood among a nationally representative sample of US young adults. We analyzed Waves I and IV restricted data from the National Longitudinal Study of Adolescent Health (n=14,111). Sexual orientation was assessed using self-reports of romantic attraction in Waves I (adolescence) and IV (adulthood). Multinomial regression models were estimated and all analyses were stratified by gender. Women attracted to the same-sex in adulthood only had lower educational attainment compared to women attracted only to the opposite-sex in adolescence and adulthood. Men attracted to the same-sex in adolescence only had lower educational attainment compared to men attracted only to the opposite-sex in adolescence and adulthood. Adolescent experiences and academic performance attenuated educational disparities among men and women. Adjustment for adolescent experiences also revealed a suppression effect; women attracted to the same-sex in adolescence and adulthood had lower predicted probabilities of having a high school diploma or less compared to women attracted only to the opposite-sex in adolescence and adulthood. Our findings challenge previous research documenting higher educational attainment among sexual minorities in the US. Additional population-based studies documenting the educational attainment of sexual minority adults are needed.

Context: Sexual minority women are not adequately assessed by national STD surveillance systems, and research regarding STD burden in nationally representative samples of such women is rare. Moreover, few studies have assessed STD risk exclusively among young adult women., Methods: Wave 4 (2007-2008) data from the National Longitudinal Study of Adolescent Health on 7,296 females aged 24-32 were used to examine the relationship between sexual orientation and receipt of an STD diagnosis in the past year. Multivariate logistic regression analyses used two measures of sexual orientation: sexual identity and gender of sex partners., Results: Eighty percent of women considered themselves straight; 16% mostly straight; and 4% bisexual, mostly gay or gay. Eighty-five percent had had only male partners, while 7% had had one female partner, and 8% two or more female partners. In unadjusted models, women who identified themselves as mostly straight were more likely than straight women to have had an STD (odds ratio, 1.4); mostly gay or gay women were at lower risk (0.4). Women who had had two or more female partners had a higher STD risk than did women who had had only male partners (1.7). Adjusting for social and demographic characteristics did not substantially alter these results; however, the associations between sexual identity, gender of sex partners and STD diagnosis were eliminated after adjustment for sexual behaviors (e.g., having had anal sex)., Conclusions: Sexual identity, gender of sex partners and sexual behaviors should be taken into account in assessments of women's STD risk., (Copyright © 2013 by the Guttmacher Institute.)

Training is an essential component of health programs that incorporate promotoras de salud (the Spanish term for community health workers) in the delivery of health education and behavioral interventions to Hispanics. During training sessions, promotoras are exposed to information and skill-building activities they need to implement the health programs. This analysis was one component of a broader study which explored program planners' approaches to recruiting and training promotoras to deliver and sustain health promotion programs for Hispanic women. The purpose of this study was to examine promotora-curriculum and training processes used to prepare promotoras to deliver health programs. The authors examined transcripts of 12 in-depth interviews with program planners and conducted a content analysis of seven different training materials used in their respective promotora programs. Interview themes and narratives included program planners' varying conceptualizations of promotora-training, including their personal definitions of "training the trainer," the practice of training a cadre of promotoras before selecting those best fit for the program, and the importance of providing goal-directed, in-depth training and supervision for promotoras. The content analysis revealed a variety of strategies used to make the training materials interactive and culturally competent. Study implications describe the importance of planners' provision of ongoing, goal-directed, and supervised training using both appropriate language and interactive methods to engage and teach promotoras.

Objective: We examined the contribution of socioeconomic disadvantage and traumatic life events to ethnic disparities in disability among Israeli adults., Method: We used data from the Survey of Health, Aging and Retirement in Europe (SHARE-Israel), a sample of Israeli adults aged 50 or older (N = 1,546). Disability measures included functional limitations, limitations in activities of daily living (ADL), and limitations in instrumental activities of daily living (IADL)., Results: Arabs and immigrants from the Former Soviet Union (FSU) experienced higher rates of functional limitations and limitations in IADLs compared to veteran Jews. The rate of having limitations in ADLs was similar for Arabs and veteran Jews, but was higher for FSU immigrants compared to veteran Jews. Inclusion of education, income, and traumatic life events attenuated, but did not eliminate ethnic disparities in disability., Discussion: Identifying factors driving ethnic health disparities in Israel is imperative if we hope to achieve health equity.

Objective: Program planners work with promotoras (the Spanish term for female community health workers) to reduce health disparities among underserved populations. Based on the Role-Outcomes Linkage Evaluation Model for Community Health Workers (ROLES) conceptual model, we explored how program planners conceptualized the promotora role and the approaches and strategies they used to recruit, select, and sustain promotoras., Design: We conducted semi-structured, in-depth interviews with a purposive convenience sample of 24 program planners, program coordinators, promotora recruiters, research principal investigators, and other individuals who worked closely with promotoras on United States-based health programs for Hispanic women (ages 18 and older)., Results: Planners conceptualized the promotora role based on their personal experiences and their understanding of the underlying philosophical tenets of the promotora approach. Recruitment and selection methods reflected planners' conceptualizations and experiences of promotoras as paid staff or volunteers. Participants described a variety of program planning and implementation methods. They focused on sustainability of the programs, the intended health behavior changes or activities, and the individual promotoras., Conclusion: To strengthen health programs employing the promotora delivery model, job descriptions should delineate role expectations and boundaries and better guide promotora evaluations. We suggest including additional components such as information on funding sources, program type and delivery, and sustainability outcomes to enhance the ROLES conceptual model. The expanded model can be used to guide program planners in the planning, implementing, and evaluating of promotora health programs.

Objectives: We examined associations among 3 dimensions of sexual orientation (identity, behavior, and attraction) and key health-related indicators commonly studied among sexual minority populations: depressive symptoms, perceived stress, smoking, binge drinking, and victimization., Methods: We analyzed data from the National Longitudinal Study of Adolescent Health, Wave IV (2007-2008) when respondents were aged 24 to 32 years (n=14,412). We used multivariate linear and logistic regressions to examine consistency of associations between sexual orientation measures and health-related indicators., Results: Strength of associations differed by gender and sexual orientation measure. Among women, being attracted to both sexes, identifying as "mostly straight" or "bisexual," and having mostly opposite-sex sexual partners was associated with greater risk for all indicators. Among men, sexual attraction was unrelated to health indicators. Men who were "mostly straight" were at greater risk for some, but not all, indicators. Men who had sexual partners of the same-sex or both sexes were at lower risk for binge drinking., Conclusions: Using all 3 dimensions of sexual orientation provides a more complete picture of the association between sexual orientation and health among young adults than does using any 1 dimension alone.

Recent studies show that racism may influence health inequities. As individuals grow from infancy into old age, they encounter social institutions that may create new exposures to racial bias. Yet, few studies have considered this idea fully. We suggest a framework that shows how racism and health inequities may be viewed from a life course perspective. It applies the ideas of age-patterned exposures, sensitive periods, linked lives, latency period, stress proliferation, historic period, and cohorts. It suggests an overarching idea that racism can structure one's time in asset-building contexts (e.g., education) or disadvantaged contexts (e.g., prison). This variation in time and exposure can contribute to racial inequities in life expectancy and other health outcomes across the life course and over generations.

Objectives: We examined whether attaining a higher educational degree after 25 years of age was associated with fewer depressive symptoms and better self-rated health at midlife than was not attaining a higher educational degree., Methods: We analyzed data from National Longitudinal Survey of Youth, restricting our sample to respondents who had not attained a bachelor's degree by 25 years of age (n = 7179). We stratified all regression models by highest degree attained by 25 years of age., Results: Among respondents with no degree, a high school diploma, or a post-high school certificate at 25 years of age, attaining at least a bachelor's degree by midlife was associated with fewer depressive symptoms and better self-rated health at midlife compared with respondents who did not attain a higher degree by midlife. Those with an associate's degree at 25 years of age who later attained a bachelor's degree or higher reported better health at midlife., Conclusions: Attaining at least a bachelor's degree after 25 years of age is associated with better midlife health. Other specifications of educational timing and its health effects across the life course should be studied.

We investigate whether school racial composition is associated with racial and ethnic differences in early adult health. We then examine whether perceived discrimination, social connectedness, and parent support attenuates this relationship. Using U.S. data from Waves I and IV of the National Longitudinal Survey of Adolescent Health, we found that black adolescents attending predominantly white schools reported poorer adult health while Asians reported better health. Further research is warranted to understand whether there are qualitative differences in the treatment of racial and ethnic minorities within certain school contexts and how that differential treatment is related to adult health outcomes., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objectives: Race/ethnicity and education are among the strongest social determinants of body mass index (BMI) throughout the life course, yet we know relatively little about how these social factors both independently and interactively contribute to the rate at which BMI changes from adolescence to midlife. The purpose of this study is to (1) examine variation in trajectories of BMI from adolescence to midlife by mothers' and respondents' education and (2) determine if the effects of mothers' and respondents' education on BMI trajectories differ by race/ethnicity and gender., Design: We used nationally representative data from the National Longitudinal Survey of Youth. Our sample included white (n=4433), black (n=2420), and Hispanic (n=1501) respondents. Self-reported height and weight were collected on 16 occasions from 1981 to 2008. We employed two-level linear growth models to specify BMI trajectories., Results: Mothers' education was inversely associated with BMI and BMI change among women. Among men, mothers' education was inversely associated with BMI; these educational disparities persisted for whites, diminished for blacks, and widened for Hispanics. Respondents' education was inversely associated with BMI among women, but was positively associated with the rate of BMI change among black women. Respondents' education was inversely associated with BMI among white and Hispanic men, and positively associated with BMI among black men. These educational disparities widened for White and Black men, but narrowed for Hispanic men., Conclusions: Our results suggest that by simultaneously considering multiple sources of stratification, we can more fully understand how the unequal distribution of advantages or disadvantages across social groups affects BMI across the life course.