Population Health and Well-Being
High Financial Strain in Combination with Internalized Expectations to “Be Strong” are Linked to Worse Mental Health among Black Women in Early Mid-life
Christy L. Erving, Izraelle I. McKinnon, Courtney S. Thomas Tobin, Miriam E. Van Dyke, Raphiel Murden, Reneé H. Moore, Bianca Booker, Viola Vaccarino, Tené T. Lewis, October 2024
Black women in the United States are expected to exude strength, suppress emotions, resist vulnerability, succeed despite structural barriers, and aid others selflessly. Known as Superwoman Schema, studies have demonstrated that Black women who endorse its dimensions experience worse mental health. Black women also experience financial strain, which also negatively impacts their mental health. In this brief, CAPS faculty affiliate Christy Erving and colleagues report on a recent study in which they used an intersectional lens to explore how multiple dimensions of Black women’s lives impact their mental health. They focus on early mid-life, a time when women are expected to fulfill their gendered obligations to take care of family while also attempting to build and advance in their careers. They found that Superwoman Schema was associated with elevated symptoms of depression; that traditional SES measures were not related to depressive symptoms but those experiencing financial strain did experience elevated depression. They also found that Black women experiencing the highest levels of financial strain who also more strongly endorsed Superwoman Schema had the highest levels of depressive symptoms. To counteract the negative impact of financial strain coupled with the cultural expectations to be strong while suppressing their emotions, the authors advocate for more culturally sensitive and accessible mental health services for Black women as well as capital investments and student loan debt relief.
Greater Neighborhood Cohesion in Childhood and in Older Adults’ Current Neighborhoods Each Predict Higher Cognitive Function
Jean Choi, Sae Hwang Han, Yee To Ng, & Elizabeth Muñoz, January 2024
Healthy cognitive function allows people to better maintain their independence and economic productivity in adulthood. A sense of neighborhood cohesion–the perceived degree of trust, reciprocity, and sense of belonging among members of a community–may be one of the modifiable factors that can promote cognitive health and delay the onset of cognitive decline. This brief, from PRC Graduate Student Trainee Jean Choi and CAPS Faculty Affiliates Sae Hwang Han and Elizabeth Muñoz and colleague used data from the Health and Retirement Survey to investigate the effects on cognitive aging of perceived neighborhood cohesion at different life stages—childhood, young adulthood, early midlife, and late midlife/late adulthood. They found that greater perceived neighborhood cohesion in childhood and late midlife/late adulthood (people ranging in age from 51 to 89 at baseline) each predicted higher cognitive function at baseline. They argue that policies to enhance people’s sense of belonging and trust in their neighborhoods across the life course can be important ways to promote healthy cognitive aging.
Older U.S. Adults Who Started Exercising After a Fall Were Less Likely to Experience Another Fall in the Following Two Years
Namkee G. Choi, C. Nathan Marti, Bryan Y. Choi, and Mark M. Kunik, October 2023
More than 25% of adults age 65 and over fall every year in the United States. Among older adults who fall, approximately 40% experience two or more falls in the same year. Falls often result from a combination of physical or functional, medical, psychological, sensory and cognitive risk factors and environmental circumstances. In recurrent falls – that is, two or more falls in a year or over a given timeframe – previous falls are the most significant additional risk factor. This brief, from CAPS Faculty Affiliate Namkee Choi and colleagues, summarizes findings from a recent study that used longitudinal data from a nationally representative sample of adults age 70 and older to examine single and recurrent fall risk and impacts over 3 years. They found that rates of falling were high among older adults; older adults who started exercising after a fall in 2019 were less likely to experience a recurrent fall in the following 2 years; both a single fall and recurrent falls were associated with a higher risk of hospitalization; older adults with recurrent falls had worse physical or functional health and more psychological health problems at baseline compared to older adults who did not fall; and racial and ethnic differences in the risk of single and recurrent falls were identified. To reduce falls among older adults, they advocate for expanding the reach of evidence-based fall prevention programs.
How Did Vaccine Hesitancy Vary for Black, White, US-born and Foreign-born Adults During Early Covid-19 Rollout Efforts?
Michelle L. Frisco, Jennifer Van Hook, and Kevin J.A. Thomas, December 2022
Recent national studies have found that Black adults were consistently more vaccine hesitant than White adults, while the evidence is mixed about Hispanic-White disparities in vaccine hesitancy. Few nationally representative studies have sought to explain why racial/ethnic disparities in vaccine hesitancy exist. In this research brief, PRC faculty scholar Kevin Thomas, along with former PRC trainees and Penn State professors Michelle Frisco and Jennifer Van Hook, explore race/ethnic and nativity disparities in Covid-19 vaccine hesitancy with nationally representative data from adults ages 18–65 collected early in vaccine rollout efforts. They found that Black and foreign-born Hispanic adults had the highest vaccine hesitancy. Anti-vaccine beliefs accounted for about 70% of the Black-White difference in vaccine hesitancy while differences between foreign-born Hispanic and White adults were mainly due to foreign-born Hispanic adults’ greater skepticism about whether the government was truthful about vaccine risks as well as their lower levels of education compared to White adults. The authors argue that widespread public education to combat anti-vaccine beliefs is a critical public health approach for alleviating Black-White inequity in vaccine hesitancy while localized efforts to reduce vaccine hesitancy among foreign-born Hispanic people are warranted in communities where it is most prevalent.
Life Expectancy for Black People Living in Former Slave Counties Is Considerably Lower Than the Life Expectancy for White People, Even after Taking a Whole Host of Factors into Account
Robert L. Reece, June 2022
Research on the long-term impacts of chattel slavery in the United States has yielded some important new understandings of the connections between the country’s past and present. This brief, from PRC faculty scholar Robert Reece, examines the connection between the number of enslaved people in counties in former slave states and life expectancy among Black and White people living in those same places today. He finds that relative to counties with fewer enslaved people in 1860, counties that had more enslaved people in 1860 have lower Black life expectancies and higher White life expectancies today, which exacerbates life expectancy inequality in those places, even after accounting for demographics, health access, local racial animus, occupational hazards, health behaviors, and neighborhood safety. He argues for the need to improve the quality of care Black Americans receive by investing in healthcare facilities that have providers—particularly Black providers—trained in the importance of reducing racial health disparities.
The Unequal Burden of Child Death Adds to Disadvantage in Psychological Distress for Black and Hispanic Parents
Debra Umberson and Rachel Donnelly, February 2022
Hundreds of studies have documented the adverse psychological consequences after parents experience the death of a child. However, very little is known about racial/ethnic variation in life course experiences following the death of a child. These gaps in knowledge are striking in the American context of systemic racism and recent public attention to grief associated with premature mortality in racial and ethnic minority communities. Using data from the Health and Retirement Study, PRC faculty scholar and CAPS co-director Debra Umberson and former PRC trainee Rachel Donnelly investigate how experiencing a child’s death is associated with parents’ subsequent psychological distress in mid to later life. They find that all parents who experienced a child’s death had higher levels of psychological distress in mid to later life than their nonbereaved counterparts but Black and Hispanic parents who experienced a child’s death had the highest levels of psychological distress. The authors advocate for more screening of bereavement-related risks in mid to later life with appropriate intervention to improve mental health outcomes. Published in partnership with UT Austin’s Center on Aging and Population Sciences.
Disclosing a Sexual Identity Is a Persistent Stressor Throughout the Lives of Sexual Minority Youth That Has Important Implications for Their Mental Health
Allen B. Mallory, Amanda M. Pollitt, Meg D. Bishop, and Stephen T. Russell, September 2021
Youth who identify as lesbian, gay, or bisexual – known collectively as sexual minority youth – experience stress associated with their nonheterosexual identity. Disclosing a sexual minority identity can be stressful and can negatively affect the mental health of sexual minority youth. Former PRC graduate research trainee and current OSU Presidential Postdoctoral Scholar, along with former PRC postdoctoral fellow Amanda Pollitt, current PRC GRA Meg Bishop and PRC faculty scholar Stephen Russell report on one of the first longitudinal studies to explore disclosure stress and depression among sexual minority youth and young adults. They found that high levels of disclosure stress was correlated with higher depression symptoms and that stressful disclosures may matter more for depression symptoms at younger ages.
School Enrollment Protects Brazilian Adolescents from Overweight and Obesity, Even for Siblings in the Same Household
Letícia J. Marteleto, Molly Dondero, Jennifer Van Hook, Luiz C. D. Gama, and Rachel Donnelly, April 2021
Children and adolescents who live in Brazil, one of the most unequal countries in the world, are now among the heaviest in the world. Traditionally, researchers have paid scant attention to the role of adolescents’ own emerging socioeconomic characteristics, measured by whether they are in school or working, on their weight status. Using a nationally representative data set that includes anthropometric measures of the height and weight of all household members, this study, led by PRC faculty research associate Letícia Marteleto and former PRC trainee Molly Dondero, examines whether and how adolescents’ school and work experiences are associated with overweight and obesity in Brazil. They find that Brazilian adolescents who are enrolled in school—both those who work and those who do not—have the lowest probabilities of being overweight or obese. They argue for robust policies that promote school retention to minimize adolescents’ risk of overweight and obesity.
Older Adults Who Live Alone Benefited from Seeing People in Person during the COVID Pandemic but Not Necessarily by Talking on the Phone
Karen L. Fingerman, Yee To Ng, Shiyang Zhang, Katherine Britt, Gianna Colera, Kira S. Birditt, and Susan T. Charles, January 2021
Approximately one-third of women and one-fifth of men aged 60 and over in the U.S. live alone and are at heightened risk of social isolation due to social distancing and other safety precautions introduced to curtail the spread of COVID-19. This brief, from PRC faculty research associate Karen Fingerman and colleagues, reports on a recent study which examines how daily positive emotions and negative emotions vary based on whether people live alone during the pandemic. They found that older adults who live alone experienced more positive emotions when they saw someone in person compared to those who had no in-person contact but that older adults who live alone experienced more negative emotions, especially loneliness, when they talked to someone on the phone. They are argue that those who want to support emotional well-being in older adults who live alone with in-person contact should do so while following COVID-19 safety guidelines.
Adolescent e-cigarette users are more likely than never-users to progress to cigarette smoking, even among those who had no intention to start smoking
Olusegun Owotomo, Haley Stritzel, Sean Esteban McCabe, Carol J Boyd, Julie Maslowsky, November 2020
E-cigarette use is a relatively new risk factor for nicotine use disorder among U.S. adolescents. Adolescents who use e-cigarettes are at increased risk of developing nicotine use disorder and progressing to smoke conventional cigarettes. In this brief, former PRC trainee Olusegun Owotomo, current PRC trainee Haley Stritzel, PRC faculty research associate Julie Maslowsky, and colleagues explore which e-cigarette users progress to cigarette smoking, and why. They find that more adolescent e-cigarette users started smoking cigarettes one year later than adolescents who had never used e-cigarettes, including those who had no intention to start smoking. The authors call on health care providers, parents, and education campaigns to emphasize the dangers associated with e-cigarette use, including the risk of progressing to cigarette smoking even among those without an intention to do so.
Liberal State Policies Improve Life Expectancy
Jennifer Karas Montez, Jason Beckfield, Julene Kemp Cooney, Jacob M. Grumbach, Mark D. Hayward, Huseyin Zeyd Koytak, Steven H. Woolf, and Anna Zajacova, October 2020
Life expectancy of people in the United States ranks last among 22 high-income countries. National averages obscure large differences within the states, which in 2017 ranged from a high of 81.6 years Hawaii to a low of 74.6 years in West Virginia. The state policy environment is critical to understanding these large disparities among U.S. states. In this study, former PRC trainee Jennifer Karas Montez, along with PRC faculty research associate Mark Hayward and co-authors, examine the impact of state policies on life expectancy in U.S. states from 1970 to 2014. They find that states that implemented more liberal policies that expanded economic regulations and protected marginalized groups saw a rise in their life expectancy while states that implemented more conservative policies were more likely to see a lowering of life expectancy for its residents.
How Do Intersecting and Overlapping Social, Environmental, Political and Economic Factors Affect Vulnerable Black Women’s Substance Use?
Liesl A. Nydegger and Kasey R. Claborn, August 2020
Black women generally have higher rates of infections, diseases and mental health problems than other groups in the United States. Systemic racism, economic and educational discrimination, and family conflicts contribute to these health disparities. Given these intersecting and overlapping social, environmental, political and economic factors that negatively affect Black women’s lives, it is helpful to employ syndemic theory, which focuses on understanding the ways in which a person’s context affects their health outcomes, to better understand vulnerable Black women’s substance use experiences. Using in-depth interviews with vulnerable Black women, PRC faculty research associate Liesl Nydegger and her Dell Medical School colleague Kasey Claborn demonstrate that this subpopulation of Black women were at high risk for unhealthy substance use and dependence. They call for policymakers to expand housing opportunities, increase funding to address intimate partner violence, and to improve the mental health treatment and substance use recovery opportunities available to low-income Black women.
Mexican Americans Show Educational Progress Across Generations When Measurement Limitations Are Overcome
Brian Duncan, Jeffrey Grogger, Ana Sofia León, Stephen J. Trejo, July 2020
Understanding how immigrants progress in educational attainment across generations is crucial for assessing the long-term impact of immigration on society. Standard data sources used to measure generational progress rely on respondents self-identifying their racial or ethnic origin. But because assimilation and intermarriage can cause ethnic attachments to fade across generations, using these subjective measures of racial/ethnic identification might miss a significant portion of the later-generation descendants of immigrants. This phenomenon, known as ethnic attrition, can hide evidence of generational progress. To overcome the data limitations of subjective measures of racial/ethnic identification, PRC faculty research associate Stephen Trejo and colleagues use data from the National Longitudinal Survey of Youth 1997 (NLSY97) that reports the countries of birth of the respondents as well as the respondents’ parents and grandparents. They find that when country of birth for respondents, parents, and grandparents is available and used to measure immigrant generation, Mexican Americans show educational improvements between the 1.5 and third generations.
Does the Death of a Child Prior to Midlife Increase Later Dementia Risk for Parents? Is this Disadvantage Greater for Black Parents than for White Parents?
Debra Umberson, Rachel Donnelly, Minle Xu, Mateo Farina, and Michael A. Garcia, December 2019
Dementia is a growing public health concern in the United States. Like other health outcomes in the U.S., the burdens of dementia are borne more heavily by black Americans than they are for white Americans. A number of biological, psychological, social, and behavioral mechanisms are associated with increased risk for dementia, but specific life course events that could trigger these mechanisms, such as the death of a child, have been largely unstudied. In this brief, PRC director Debra Umberson, former PRC graduate student trainees Rachel Donnelly and Minle Xu, and PRC graduate student trainees Mateo Farina and Michael A. Garcia use Health and Retirement Study data to show that the death of a child prior to midlife increases dementia risk for both black and white parents. Black parents are disadvantaged in that they are more likely than white parents to experience the death of a child, and such losses add to the already substantial racial disadvantage in dementia risk.
Do Transgender Women and Men Have Worse Health Outcomes if Their Voices Are Perceived as Inconsistent with Their Gender Identity?
Danya Lagos, October 2019
Transgender people in the United States are more likely to experience worse overall health than cisgender (non-transgender) people. Within the U.S. transgender population, differences in expressions of gender identity are linked to health disparities. In social interactions, people typically ascribe gender to others by using cues from embodied characteristics associated with sex differences, such as voices, body shape, and hair growth patterns. Voices, particularly gendered voices, can shape relative social advantage and disadvantage. In this brief, PRC postdoctoral fellow Danya Lagos isolates the link between voice-based gender misclassification and patterns of health inequality within the transgender population. She finds that for both transgender women and transgender men, being perceived as a woman over the phone is associated with worse overall health.
When Older People Interact with Weak Social Ties, They Get Up and Move
Karen L. Fingerman, Meng Huo, Susan T. Charles, and Debra J. Umberson, July 2019
Decades of research demonstrate the importance of social relationships on well-being in later life. Most of these studies have focused on the impact of close ties on physical and emotional health. This brief, from PRC faculty research associate Karen Fingerman and colleagues, reports on a study that breaks new ground by measuring the association of both close social ties and weak social ties on physical activity and mood. They find that older adults who interact with more weak social ties engage in more physical activity while encounters with close ties improve mood more.
The Impact of Poverty and Discrimination on Child Height in India
Diane Coffey, Ashwini Deshpande, Jeffrey Hammer, and Dean Spears, March 2019
This brief describes disparities in child height – an important indicator of early life health – in India. The authors find that socioeconomic differences explain why Scheduled Tribe children, who often grow up geographically and socially isolated from other groups, are shorter than general caste children. However, socioeconomic variables alone do not explain why Scheduled Caste children are shorter than general caste children. Instead, height gaps between Scheduled Caste and general caste children are explained by a combination of SES variables and the fraction of households in a Scheduled Caste child’s neighborhood that outrank her household in the caste system. This may be because pregnant mothers experience more stress when they live near general caste neighbors or it may be because of the particular ways in which the general castes enforce their social dominance over Scheduled Castes, such as limiting Scheduled Caste families’ use of clean water.
How Does the Transmission of Diet Behaviors Differ by Parent and Child Gender in Brazil?
Rachel Donnelly and Letícia J. Marteleto, February 2019
Diet is a key driver of obesity and a key mechanism in the transmission of obesity from parent to child. While past research in this area has primarily focused on the influence of mothers on the diets of their children, this brief, from PRC graduate student Rachel Donnelly and PRC faculty research associate Letícia Marteleto, reports on research that examines the influence of mothers and fathers on the diets of their daughters and sons in Brazil. They find that mothers’ diets have a stronger association with their daughters’ diets than fathers’ diets in lower-socioeconomic households. They argue that policies aiming to reduce the burden of obesity and improve nutrition among Brazilian children should consider improving the diets and health of parents, especially mothers.
What Happens during Healthcare Interactions to Compel Gender Nonconforming LGBTQ People to Avoid Healthcare?
Emily Allen Paine, October 2018
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals experience worse health throughout their lives compared to their heterosexual and cisgender (non-transgender, hereafter cis) peers, yet LGBTQ individuals are more likely to avoid healthcare. In addition, gender nonconforming LGBTQ individuals report more discrimination and avoid healthcare more often than their conforming counterparts. Using in-depth interviews with LGBQ cis women, transgender men, and nonbinary individuals, PRC graduate student trainee Emily Allen Paine shows the ways that healthcare interactions stigmatize gender nonconforming LGBTQ individuals which in turn discourages them from seeking care.
What is the Impact of Racial and Ethnic Discrimination on Adolescents’ Well-Being?
Aprile D. Benner, Yijie Wang, Yishan Shen, Alaina E. Boyle, Richelle Polk, and Yen-Pi Cheng, September 2018
Racial and ethnic disparities are common across multiple domains in the United States and likely rooted in experiences of discrimination that occur early in individuals’ lives. In this brief, PRC faculty research associate Aprile D. Benner and colleagues report on a meta-analysis that examines whether adolescents’ perceptions of racial and ethnic discrimination are negatively linked to their well-being. They found that greater experiences of racial and ethnic discrimination are associated with higher levels of socioemotional distress, a higher likelihood of engaging in risky health behaviors and lower academic achievement. They also found that discrimination poses the greatest risk for Latino youth and younger adolescents.
Transgender Youth Allowed to Use Their Chosen Name Have Fewer Mental Health Problems
Stephen T. Russell, Amanda M. Pollitt, Gu Li, and Arnold H. Grossman, June 2018
This brief, from PRC researchers Stephen Russell and Amanda Pollitt and colleagues, examines the relationship between chosen name use—which is a proxy for youths’ gender affirmation in various contexts—and mental health among transgender youth. The authors find that transgender youth who were able to use their chosen name at home, in school, at work, and with friends had lower levels of severe depression, suicidal ideation, and suicidal behavior.
Black Deaths Matter: A Conceptual Framework for Understanding Racial Disparities in Relationship Loss and Health
Debra Umberson, January 2018
Black Americans are more likely than white Americans to experience the premature death of mothers, fathers, siblings, children, and other relatives and friends. In this brief, PRC director Debra Umberson presents a conceptual framework for understanding how disparities in loss launch a lifelong cascade of psychological, social, behavioral, and biological consequences that undermine social connections, health, and well-being over the life course for black Americans.
Adolescent E-cigarette Users’ Perceptions of the Harm and Addictiveness of Conventional Cigarette Smoking
Olusegun Owotomo, Julie Maslowsky, and Alexandra Loukas, October 2017
As the popularity of e-cigarettes continues to rise and their link with conventional cigarette smoking becomes clearer, it is important to understand how e-cigarette users compare with non-users, conventional cigarette smokers, and dual users on perceptions of addiction risk of conventional cigarette smoking as well as on other risk factors associated with smoking. PRC graduate student trainee Olusegun Owotomo, PRC faculty research associate Julie Maslowsky, and co-author Alexandra Loukas found that adolescent e-cigarette users endorsed a number of attitudes, perceptions, and characteristics that are risk factors for conventional cigarette smoking. These perceptions may leave them vulnerable to becoming conventional cigarette smokers or dual users in the future and potentially increase their risk for nicotine addiction.
Open Defecation and Anemia in Children: The Case of Nepal
Diane Coffey, Michael Geruso, and Dean Spears, May 2017
Anemia is typically thought of as a nutritional outcome, with a corresponding policy focus on improving nutrient intake. PRC faculty research associates Diane Coffey, Michael Geruso, and Dean Spears convincingly show that the disease environment affects nutrient absorption. Therefore, interventions to address anemia should also focus on reducing parasitic infections that are transmitted through open defecation. They make the case that policy makers interested in reducing anemia in developing countries should also prioritize reducing open defecation.
Do U.S. States’ Socioeconomic and Policy Contexts Shape Differences in Adult Disability?
Jennifer Karas Montez, Mark D. Hayward, and Douglas A. Wolf, March 2017
Using nationally-representative data from the American Community Survey, the authors, including former PRC graduate trainee Jennifer Karas Montez and current PRC faculty research associate Mark Hayward, apply the World Health Organization’s socio-ecological framework to determine if differences in adult disability exist across states and, if so, what are possible explanations for those differences. The research finds that disparities in adult disability across U.S. states are substantial, and a significant fraction of disparities arises from economic or social policies at the state level.
How Losing Family Members Earlier than Expected Adds to Racial Disadvantage for U.S. Blacks
Debra Umberson, January 2017
PRC director Debra Umberson uses nationally representative data from the National Longitudinal Survey of Youth and the Health and Retirement Study to estimate the differences by race in the likelihood that Blacks will be exposed to more deaths of close family members than Whites throughout their lives. The data shows that Black Americans experience more family member deaths than Whites overall, and specific losses occur earlier in life. Studying this question is important because it could reveal an added layer of racial disadvantage suffered by Blacks that is not captured by differences in life expectancy or mortality alone.
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