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Health equity research has identified fundamental social causes of health, many of which disproportionately affect Black Americans, such as early life socioeconomic conditions, neighborhood disadvantage, and racial discrimination. However, the role of life course factors in premature mortality among Black Americans has not been tested extensively in prospective samples into later adulthood. To better understand how social factors at various life stages impact mortality, this study examines the effect of life course poverty, neighborhood disadvantage, and discrimination on mortality and factors that may buffer their effect (i.e., education, social integration) among the Woodlawn cohort (N = 1242), a community cohort of urban Black Americans followed since 1966. Taking a life course perspective, we analyze mortality data for deaths through age 58 years old, as well as data collected at ages 6, 16, 32, and 42. At age 58, 204 (16.4%) of the original cohort have died, with ages of death ranging from 9 to 58.98 (mean = 42.9). Cox proportional hazard models adjusting for confounders show statistically significant differences in mortality risk based on timing and persistence of poverty; those who were never poor or poor only in early life had lower mortality risk at ages 43-58 than those who were persistently poor from childhood to adulthood. Education beyond high school and high social integration were shown to reduce the risk of mortality more for those who did not experience poverty early in their life course. Findings have implications for the timing and content of mortality prevention efforts that span the full life course.

Objective: This study evaluated variation in substance use and mental health among graduate student subgroups. Participants: A sample of 2,683 master's and doctoral students completed an online survey in October 2017. Methods: Subgroup variation in behavioral health by demographic and program characteristics, particularly degree type and academic discipline, was explored. Results: Compared with academic doctoral students (ie, PhD students), professional doctoral students (ie, MD, JD, etc.) were significantly more likely to report high stress levels and moderate or severe anxiety symptoms. Master's students were more likely to report moderate or severe anxiety symptoms and use marijuana than academic doctoral students. Students in the behavioral and social sciences, social work, and arts and humanities disciplines were more likely to use substances and report mental health problems than engineering and business students. Conclusions: These findings highlight graduate student subgroups who might require closer attention with respect to access to behavioral health services.

Background: Understanding racial differences in teenage fathers' early risk factors and later outcomes is critical to inform programs for teenage fathers as our knowledge base on this population remains limited. Objective: The goal of this study was to assess how teen fathers' characteristics, including family background, delinquency, living arrangements, socioeconomic resources, and arrests, vary over time by race and ethnicity. Method: We analyzed National Longitudinal Study of Adolescent to Adult Health data. The analytic sample consisted of self-identified African American, Latino, and White males who fathered a child before the age of 20 (n = 313). Data come from three time points: adolescence, transition to adulthood, and young adulthood. Results: Latino teen fathers came from families with lower educational attainment and greater reliance on public assistance. No statistically significant differences by race and ethnicity were found in parental involvement, school connectedness, marijuana use, and delinquency during adolescence. By their early 20s, a lower proportion of African American teen fathers were married compared to White and Latino teen fathers. By young adulthood, adjusted regression analyses showed that African American teen fathers were more likely to be arrested and earned a lower mean income than White teen fathers. Conclusions: Findings suggest that African American teen fathers, while no more disadvantaged or delinquent than the other two groups in their adolescence, experience greater accumulation of disadvantages over the life course. Intervention programs must consider the broader social and institutional context that may contribute to the disproportionate disadvantage among African American teen fathers in their young adulthood.

Background: Alcohol use has profound public health impact on women; however, modifiable factors that may influence alcohol use progression/recovery, including health service utilization, are understudied in women. Objective: To investigate the association between mental health (MH) and substance use (SU) treatment with alcohol use progression and recovery among women who currently use alcohol or have in the past. Methods: This study is a secondary data analysis of prospective data from waves 1 (2001–2002) and 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; a US-nationally representative sample of adults). The analytic sample was limited to women who reported past or current alcohol use at wave 1 (N = 15,515). Latent transition analysis (LTA) examined whether receiving SU/MH treatment in the year prior to wave 1 was associated with transitioning between three empirically-derived stages of alcohol involvement (no, moderate, and severe problems classes), between Waves 1 and 2 adjusting for possible confounders using propensity score weight. Results: Compared to White female drinkers, female drinkers who were from Black, Hispanic, or other races were less likely to receive SU/MH treatment (p-values ≤. 001). SU/MH treatment in the year prior to wave 1 was associated with transitioning from the moderate problems class to the no problems class between Waves 1 and 2 (p-value =.04). Conclusion: Receipt of SU or MH treatment among women, was associated with a higher likelihood of remission from moderate alcohol use problems to no problems over time. Future research, including investigation into treatment characteristics (e.g., frequency, duration, type) should further explore why women initially experiencing severe alcohol use problems did not experience similar remission. [ABSTRACT FROM AUTHOR]

Despite the importance of evaluation to successful programming, a lack of physical activity program (PAP) evaluation for American Indian/Alaska Native (AI/AN) programs exists, which is significant given the high rates of obesity and diabetes in this population. While evaluation barriers have been identified broadly among AI/AN programs, challenges specific to physical activity (PA) programming are unexplored. To address this gap, a research study was conducted involving 17 in-depth interviews with evaluation staff of externally funded AI/AN PAPs. A thematic analysis revealed factors hindering meaningful program evaluation: cultural characteristics that challenge traditional evaluation, the logistics of PA programming, measurement and data collection challenges, lack of resources and support, and lack of alignment between funding agency requirements and the evaluation desired by AI/AN organizations. Some challenges are general to PAPs and others specific to AI/AN organizations. Findings identify ways to improve culturally responsive evaluation for AI/AN PAPs.

Adolescence is a particularly important and challenging time for developing long-lasting romantic relationship patterns. However, limited empirical research has explored teen perceptions of ideal partner characteristics during adolescence or their significance to the quality of current and future relationships. Semi-structured in-depth interviews were conducted with 33 African American high school girls to shed light on the qualities desired in their dating relationships and relational factors that influence teen dating behaviors. Guided by the Social Ecological Framework, interviews were transcribed verbatim and entered into ATLAS.ti, for coding and analysis. Girls discussed the important influence of parents in choosing a partner and provided positive depictions of friendship and marriage with a suitable partner. More research is needed to understand how and why adolescents desire particular characteristics, how socialization shapes teen perceptions, and how these preferences may be related to current and future adolescent dating choices, including violence perpetration and victimization.

BackgroundSocial media platforms such as Twitter can serve as a potential data source for public health research to characterize the social neighborhood environment. Few studies have linked Twitter-derived characteristics to individual-level health outcomes. ObjectiveThis study aims to assess the association between Twitter-derived social neighborhood characteristics, including happiness, food, and physical activity mentions, with individual cardiometabolic outcomes using a nationally representative sample. MethodsWe collected a random 1% of the geotagged tweets from April 2015 to March 2016 using Twitter’s Streaming Application Interface (API). Twitter-derived zip code characteristics on happiness, food, and physical activity were merged to individual outcomes from restricted-use National Health and Nutrition Examination Survey (NHANES) with residential zip codes. Separate regression analyses were performed for each of the neighborhood characteristics using NHANES 2011-2016 and 2007-2016. ResultsIndividuals living in the zip codes with the two highest tertiles of happy tweets reported BMI of 0.65 (95% CI –1.10 to –0.20) and 0.85 kg/m2 (95% CI –1.48 to –0.21) lower than those living in zip codes with the lowest frequency of happy tweets. Happy tweets were also associated with a 6%-8% lower prevalence of hypertension. A higher prevalence of healthy food tweets was linked with an 11% (95% CI 2% to 21%) lower prevalence of obesity. Those living in areas with the highest and medium tertiles of physical activity tweets were associated with a lower prevalence of hypertension by 10% (95% CI 4% to 15%) and 8% (95% CI 2% to 14%), respectively. ConclusionsTwitter-derived social neighborhood characteristics were associated with individual-level obesity and hypertension in a nationally representative sample of US adults. Twitter data could be used for capturing neighborhood sociocultural influences on chronic conditions and may be used as a platform for chronic outcomes prevention.

Background: Structural racism is how society maintains and promotes racial hierarchy and discrimination through established and interconnected systems. Structural racism is theorized to promote alcohol and tobacco use, which are risk factors for adverse health and cancer-health outcomes. The current study assesses the association between measures of state-level structural racism and alcohol and tobacco use among a national sample of 1,946 Black Americans. Methods: An existing composite index of state-level structural racism including five dimensions (subscales; i.e., residential segregation and employment, economic, incarceration, and educational inequities) was merged with individual-level data from a national sample dataset. Hierarchical linear and logistic regression models, accounting for participant clustering at the state level, assessed associations between structural racism and frequency of alcohol use, frequency of binge drinking, smoking status, and smoking frequency. Two models were estimated for each behavioral outcome, one using the composite structural racism index and one modeling dimensions of structural racism in lieu of the composite measure, each controlling for individual-level covariates. Results: Results indicated positive associations between the incarceration dimension of the structural racism index and binge drinking frequency, smoking status, and smoking frequency. An inverse association was detected between the education dimension and smoking status. Conclusions: Results suggest that state-level structural racism expressed in incarceration disparities, is positively associated with alcohol and tobacco use among Black Americans. [ABSTRACT FROM AUTHOR]

Research on the long-term relationship between offending and mortality is limited, especially among minorities who have higher risk of premature mortality and criminal offending, particularly arrest. Using Cox proportional hazard models, we estimate the relationship between young adult offending and later mortality (to age 58) among a community cohort of Black Americans (n  = 1,182). After controlling for a wide range of covariates, results indicate that violent offenders are at heightened risk of mortality from young adulthood through midlife compared with both non-violent only offenders and non-offenders. Further analysis shows that this result is driven by the frequent, largely non-violent, arrests incurred among violent offenders. Criminal justice reform and collaboration with public health practitioners might be fruitful avenues to reduce mortality disparities. [ABSTRACT FROM AUTHOR]

Although previous studies have identified a protective effect of marriage on risky health behaviors, gaps remain in our understanding of how marriage improves health, particularly among African Americans. This study uses longitudinal data to take selection into account and examines whether marital trajectories that incorporate timing, stability, and duration of marriage affect health risk behaviors among a community cohort of urban African Americans followed for 35 years (N = 1,049). For both men and women, we find six marital trajectories. Men and women in consistently married trajectories are less likely to smoke, drink heavily (women only), and use illegal drugs than those in unmarried or previously married trajectories. Late marrying men do not fare worse in midlife than men in earlier marrying trajectories, but late marrying women show increased risk of midlife drug use. Results suggest policies supporting marriage may have an impact on health but only if stable unions are achieved. (Contains 4 tables and 2 figures.)

Using longitudinal data from the Woodlawn Project (N = 680), this study examined how patterns of living arrangements among a community cohort of African American mothers were associated with later physical and emotional health. We identified eight patterns of stability and transition in living arrangements during the childrearing years. Health outcomes include SF-36 Physical Functioning, SF-36 Bodily Pain, depressed mood, and anxious mood. Specific patterns of living arrangements were related to later health, controlling for age, earlier health, education, and poverty. Poverty explained many, but not all, of the relationships between living arrangements and health. Findings underscored the benefits of social support and social integration and highlighted the negative effects of marital dissolution on health.

This study examines pathways to adult marijuana and cocaine use in a cohort of African Americans from Woodlawn, an inner city community in Chicago. Assessments were conducted in first grade (age 6), adolescence (age 16), early adulthood (age 32), and in mid-adulthood (age 42). The "social adaptation life course" framework guided the focus on social adaptation, social bonds, and economic resources as predictors of adult drug use. Results indicate that more frequent substance use in adolescence and lower-income and less-frequent church attendance in early adulthood increase the risk of mid-life drug use. Shyness in first grade related inversely to later cocaine use and marijuana use (marginally significant). Indirect pathways to drug use also were identified. Gender differences were not significant. The findings show continuities in social maladaptation over time and the importance of social integration and economic resources in the early adult years. (Contains 3 figures, 2 tables and 1 note.)

Matching methods such as nearest neighbor propensity score matching are increasingly popular techniques for controlling confounding in nonexperimental studies. However, simple k:1 matching methods, which select k well-matched comparison individuals for each treated individual, are sometimes criticized for being overly restrictive and discarding data (the unmatched comparison individuals). The authors illustrate the use of a more flexible method called full matching. Full matching makes use of all individuals in the data by forming a series of matched sets in which each set has either 1 treated individual and multiple comparison individuals or 1 comparison individual and multiple treated individuals. Full matching has been shown to be particularly effective at reducing bias due to observed confounding variables. The authors illustrate this approach using data from the Woodlawn Study, examining the relationship between adolescent marijuana use and adult outcomes.

The authors examined the effects of heavy adolescent marijuana use on employment, marriage, and family formation and tested both dropping out of high school and adult marijuana use as potential mediators of these associations among a community sample of African Americans followed longitudinally from age 6 to age 32-33. They used propensity score matching to reduce selection bias when estimating the effects of heavy adolescent marijuana use. Logistic regression results on the sample matched on sex, and early demographic and behavioral variables showed that adolescent marijuana use has adult social behavioral consequences: Use of marijuana 20 times or more during adolescence was associated with being unemployed and unmarried in young adulthood and having children outside of marriage for both males and females. Dropping out of high school and more frequent adult marijuana use seem to be important parts of the pathway from adolescent marijuana use to negative life outcomes.

Suicide is a problem on the rise but not studied extensively among African Americans. It is critical to identify risk factors for suicidal ideation to reduce risk. This study examines whether family and social factors over the life course predict suicidal ideation among African American adults in midlife. We conducted multiple logistic regression analyses on data from a longitudinal cohort of African Americans first assessed in childhood to identify associations with suicidal ideation in midlife (ages 33–42). Findings suggested living without one's mother in childhood (vs. living with mother alone; aOR = 3.69, p =.017) and parental rule-setting in adolescence (aOR = 0.79, p =.047) were associated with suicidal ideation. Having a lifetime drug disorder (aOR = 2.19, p =.046) or major depression by young adulthood (aOR = 3.58, p <.001) was also associated with an increased risk of suicidal ideation. Findings highlight the importance of intervention for children in mother-absent homes for improving mental health outcomes. Family interventions that promote parental rule-setting and addressing drug problems and depressive symptoms early in the life course offer an area for intervention to reduce suicide over the long term. [ABSTRACT FROM AUTHOR]