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By 2060, the number of individuals in the United States with Alzheimer's disease and related dementias (ADRDs) is projected to triple to about 13.9 million, with Latinos experiencing the largest increase. Research has shown that both parental and own education impact late-life cognitive health, and upward educational mobility from one generation to the next may partially compensate for the adverse cognitive health effects of low parental education. However, it remains unclear to what extent gains in educational attainment may help individuals with low parental education attain cognitive health benefits similar to those with multiple generations of high levels of education. Given the significance of education as a modifiable risk factor for ADRDs, it is critical to understand how generational increases in education in the US impact cognitive health, especially among marginalized racial and ethnic groups with historically limited access to education. Understanding how the cognitive health benefits of higher education compare for individuals who are first-generation and individuals who have benefited from multiple generations of high levels of education and how this varies across race and ethnicity can inform social policies to address cognitive health disparities due to low education levels. This dissertation aims to examine the relationship between intergenerational education and cognitive health using data from the US Health and Retirement Study (HRS) and the Study of Latinos – Investigation of Neurocognitive Aging (SOL-INCA), a large cohort of Latino older adults, and investigate whether the association differs for older Black, Hispanic, and White adults and within Latino heritage subgroups (e.g. Cuban, Dominican, etc.). Additionally, this dissertation makes a significant contribution to the literature as the first study to evaluate the relationship between highly educated offspring and cognitive health for Latinos in the US. The first chapter of my dissertation examined the association between being a first-generation high school graduate (i.e., neither parent graduated high school) vs. being a multi-gen high school graduate (i.e., at least one parent graduated high school) and cognitive performance, decline, and incidence of possible cognitive impairment no dementia (CIND) or probable dementia for Black, Latino, and White older adults. Compared to multi-generational high school graduates, first-generation graduates had notably lower baseline verbal learning and memory z-scores. Black and White first-generation graduates experienced a faster rate of decline in verbal learning compared to their multi-generational counterparts; rates did not differ for Hispanic graduates. First-generation high school graduates also had higher hazard ratios of possible CIND or probable dementia compared to multi-generational high school graduates, with the greatest difference among White respondents. Recognizing that Hispanic and Latino older adults are not a monolithic group, the second chapter examined the association between upward intergenerational educational mobility and cognitive outcomes within Latino subgroups. Specifically, we evaluated the association between being a first-generation (vs. multi-generation) high school graduate and cognitive performance and cognitive change, by Latino heritage group and nativity (US-born vs. non-US born). Compared to their multi-gen counterparts, first-generation Cuban, Mexican, and Puerto Ricans scored significantly lower on verbal learning. First-generation respondents born outside the US scored significantly lower across domain-specific and global cognitive outcomes. Finally, the third chapter focuses on the education of younger generations and examines how the education of older adults’ offspring is associated with their cognitive function, decline, and incidence of possible CIND or probable dementia. We found that each year of offspring education over 12 years was associated with higher baseline verbal learning and memory z-scores and a slightly faster rate of decline in verbal learning. Furthermore, Hispanic participants had a lower risk of possible CIND or probable dementia compared to their White counterparts with each additional year of offspring education over 12 years. Together, these studies provide further evidence into the importance of investing in education across generations, particularly when considering differences by race and ethnicity. Our findings suggest that dementia risk reductions attributable to higher levels of intergenerational educational attainment may continue to accrue in the future, which could help address inequities in cognitive health between populations with different educational backgrounds.

This dissertation explores the role of educational characteristics as a marker of cognitive resilience. Incident stroke is often accompanied by acute deficits and declines in cognitive ability as well as long-term acceleration of cognitive decline. These resulting impairments and dementia drastically affect quality of life, and patients with dementia after stroke are at increased risk of death and disability. Education has been consistently identified as a predictor of cognition after stroke, but mechanisms behind this relationship are not fully understood. One hypothesis considers cognitive resilience, suggesting that education provides individuals with cognitive tools to maintain cognitive functioning amidst a clinically meaningful amount of neurodegeneration or injury. However, studies of this relationship are hindered by a lack of universally accepted definitions of cognitive resilience. Furthermore, some studies suggest that the commonly used measure of attained education may not capture variation in cognition as well as alternative measures such as educational quality and literacy. The relationship between stroke and dementia has the potential to be used to study cognitive resilience and reserve, a critical issue in cognitive aging research. By using stroke as a well-defined and clearly diagnosed disease with a known time of event onset, studies can be conducted to assess for differences between educational subgroups and to differentiate between normal-age related decline and disease-related pathological processes. Therefore, this proposal aims to investigate the influence of educational characteristics on cognitive resilience after stroke. Chapter 1 examines memory trajectories before, at the time, and after stroke in a nationally representative sample to assess where along the development of stroke education may benefit cognition. More years of attained education was associated with a small decrease in memory decrement at the time of stroke and a slight slowing of memory decline after stroke onset. However the benefits of education lie primarily in pre-existing cognitive reserve prior to stroke, with individuals of higher attained education declining only slightly slower than individuals with lower education. Chapter 2 estimates the extent to which educational characteristics modify the effect of history of stroke on dementia risk, finding that state-level administrative school quality is a predictor of late-life dementia incidence, independently of own educational attainment. Chapter 3 investigates whether education influences individuals’ cognitive responses to markers of disease pathology in the brain, finding that contrary to previous studies, the relationship between white matter hyperintensities and cognition does not differ by level of education. Together, these studies address the gap in understanding of mechanisms behind cognitive resilience by investigating whether increases in education allow people to maintain cognitive functioning following the onset of disease, and assessing where education is most beneficial along the development of disease.

IRET Following a 2019 workshop led by the Center for Global Health Studies at the Fogarty International Center on the topic of childhood obesity prevention and research synergies transpiring from cross-border collaborations, we convened a group of experts in the United States and Latin America to conduct a narrative review of the epidemiological literature on the role of obesogenic endocrine disrupting chemicals (EDCs) in the etiology of childhood obesity among Latino youth in the United States and Latin America. In addition to summarizing and synthesizing results from research on this topic published within the last decade, we place the findings within a lifecourse biobehavioral framework to aid in identification of unique exposure-outcome relationships driven by both biological and behavioral research, identify inconsistencies and deficiencies in current literature, and discuss the role of policy regulations, all with the goal of identifying viable avenues for prevention of early life obesity in Latino/Hispanic populations. Luego de un taller de 2019 dirigido por el Centro de Estudios de Salud Global en el Centro Internacional Fogarty sobre el tema de la prevención de la obesidad infantil y las sinergias de investigación que surgen de las colaboraciones transfronterizas, reunimos a un grupo de expertos en los Estados Unidos y América Latina para llevar a cabo un revisión narrativa de la literatura epidemiológica sobre el papel de los disruptores endocrinos (EDC) obesogénicos en la etiología de la obesidad infantil entre los jóvenes latinos en los Estados Unidos y América Latina. Además de resumir y sintetizar los resultados de la investigación sobre este tema publicada en la última década, colocamos los hallazgos dentro de un marco bioconductual del ciclo de vida para ayudar en la identificación de relaciones únicas de exposición-resultado impulsadas por investigaciones tanto biológicas como conductuales, identificar inconsistencias y deficiencias en literatura actual y discutir el papel de las regulaciones políticas, todo con el objetivo de identificar vías viables para la prevención de la obesidad en la vida temprana en las poblaciones latinas / hispanas. University of Colorado Denver Anschutz Medical Campus, USA Instituto Nacional de Salud Pública, México School of Public Health and Health Professions, USA Brown University, USA University of California Berkeley, USA Universidad Nacional, Costa Rica Universidad de Chile, Chile Universidad de São Paulo, Brasil Harvard T.H. Chan School of Public Health, USA University of Southern California Keck School of Medicine, USA University of Michigan School of Public Health, USA Instituto Regional de Estudios en Sustancias Tóxicas

Objective: Our objective was to use longitudinal data from a US birth cohort to test whether the probability of overweight or obesity during the first 6 years of life varied according to socioeconomic status. Design and Methods: Using six waves of longitudinal data from full-term children in the Early Childhood Longitudinal Study-Birth Cohort (2001-2007; n≈4,950), we examined the prevalence of overweight or obesity (Body Mass Index (BMI) >2 standard deviations above age- and sex- specific WHO Childhood Growth Standard reference mean; henceforth, "overweight/obesity") according to age, socioeconomic status, and race/ethnicity using generalized estimating equation models. Results: The association between socioeconomic status and overweight/obesity varied significantly by race/ethnicity, but not by sex. Overweight/obesity was significantly associated with socioeconomic status among whites, Hispanics and Asians; the adjusted odds of overweight/obesity began to diverge according to SES after the first 9 months of life. By approximately 4 years, children with the highest SES had a significantly lower odds of overweight/obesity. SES was not significantly related to overweight/obesity among African Americans and American Indians during early childhood. Conclusions: Few studies have assessed the associations between SES and overweight/obesity within racial/ethnic groups in the US. We find that in contemporary, US-born children, SES was inversely associated with overweight/obesity among more racial/ethnic groups (whites, Hispanics, and Asians) than previously reported. © 2014 Jones-Smith et al.