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While we have the tools to achieve this goal, the persistent barriers to healthcare services experienced by too many individuals will need to be addressed to make significant progress and improve the health and quality of life of all people with human immunodeficiency virus (HIV). The necessary structural changes require actions by federal, state, and local policymakers and range from ensuring universal access to healthcare services to optimizing care delivery to ensuring a robust and diverse infectious diseases and HIV workforce. In this article, we outlines 10 key principles for policy reforms that, if advanced, would make ending the HIV epidemic in the United States possible and could have much more far-reaching effects in improving the health of our nation. [ABSTRACT FROM AUTHOR]

Background and Objectives Population aging has led to an increased interest in cognitive health and, in particular, the role that stress plays in cognitive disparities. This paper extends previous work by characterizing coronavirus disease 2019 (COVID-19) stress type prevalence and its association with cognitive health in metro-Detroit among Black, Middle Eastern/Arab (MENA), and White older adults. Research Design and Methods Data come from a regionally representative sample of adults aged 65+ in metro-Detroit (N = 600; MENA n = 199; Black n = 205; White n = 196). We used generalized linear models to compare groups on sociodemographic, objective stress, and social stress indicators. Multiple group structural equation models evaluated whether COVID-19 stress predicted cognitive health and whether that association varied across racial/ethnic groups. Results MENA and Black older adults reported higher levels of objective stress than Whites. There were no racial/ethnic group differences in social stress. More objective stress was associated with better cognitive health, and more social stress was associated with worse cognitive health. The positive effect of objective stress was especially apparent for White older adults. Discussion and Implications Though it appears that minority stress was not exacerbated in the context of pandemic stress, links between greater objective stress and better cognitive health apparent among White older adults were not evident among MENA or Black older adults. Broadening health disparities research by including underrepresented populations allows us to elevate scientific knowledge by clarifying what is universal and what is unique about the stress process. [ABSTRACT FROM AUTHOR]

Objectives The United States has seen increasing shifts toward home- and community-based services (HCBS) in place of institutional care for long-term services and supports. However, research has neglected to assess whether these shifts have improved access to HCBS for persons with dementia. This paper identifies HCBS access barriers and facilitators, and discusses how barriers contribute to disparities for persons with dementia living in rural areas and exacerbate disparities for minoritized populations. Methods We analyzed qualitative data from 35 in-depth interviews. Interviews were held with stakeholders in the HCBS ecosystem, including Medicaid administrators, advocates for persons with dementia and caregivers, and HCBS providers. Results Barriers to HCBS access for persons with dementia range from community and infrastructure barriers (e.g. clinicians and cultural differences), to interpersonal and individual-level barriers (e.g. caregivers, awareness, and attitudes). These barriers affect the health and quality of life for persons with dementia and may affect whether individuals can remain in their home or community. Facilitators included a range of more comprehensive and dementia-attuned practices and services in health care, technology, recognition and support for family caregivers, and culturally competent and linguistically accessible education and services. Discussion System refinements, such as incentivizing cognitive screening, can improve detection and increase access to HCBS. Disparities in HCBS access experienced by minoritized persons with dementia may be addressed through culturally competent awareness campaigns and policies that recognize the necessity of familial caregivers in supporting persons with dementia. These findings can inform efforts to ensure more equitable access to HCBS, improve dementia competence, and reduce disparities. [ABSTRACT FROM AUTHOR]

Objective The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). Method We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. Results The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. Conclusions More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access. [ABSTRACT FROM AUTHOR]

The perverseness of racial and ethnic inequities in the United States continues to implore the investigation of their causes. While there have been improvements in the health of the US population, these improvements have not been equally distributed. To commemorate the 100th anniversary of the American Journal of Epidemiology , in this commentary, we aim to highlight the Journal 's contributions to: 1) the definition and use of race and ethnicity in research, and 2) understanding racial and ethnic inequities, both empirically and methodologically, over the past decade. We commend the Journal for its contributions and for spearheading many of the challenges related to measuring and interpreting racial and ethnic data for the past 20 years. We identify 3 additional areas in which the Journal could make further impact to address racial and ethnic inequities: 1) devote a section in every issue of the Journal to scientific papers that make substantive epidemiologic or methodological contributions to racial and ethnic inequities in health; 2) update the Journal 's guidelines for authors to include justifying the use of race and ethnicity; and 3) diversify the field of epidemiology by bringing a new cadre of scholars from minoritized racial and ethnic groups who represent the most affected communities into the research process. [ABSTRACT FROM AUTHOR]

Objectives Previous research in the United States suggests contextual income mobility may play a role in explaining the disparities between life expectancy in the United States and peer countries. This article aims to extend previous research by estimating the consequences of average individual exposure to mobility regimes during childhood and adolescence on adult health. Methods This study draws its data from two longitudinal datasets that track the county of residence of respondents during childhood and adolescence, the Panel Study of Income Dynamics and the National Longitudinal Survey of Youth 1997. We implement marginal structural models to assess the association of the average exposure to county income mobility on five health outcomes and behaviors. Results The results are only partially consistent with a systematic association between exposure to income mobility and health outcomes. Evidence obtained from the National Longitudinal Survey of Youth suggests less income mobility might increase the probability of smoking by age 30. Discussion The paper provides a precise assessment of the hypothesis that childhood exposure to income mobility regimes may influence health status through behavior later in life and contribute to longevity gaps. Only partial evidence on smoking suggests an association between income mobility and health, so we discuss potential reasons for the disparities in results with previous research. [ABSTRACT FROM AUTHOR]

In the past several years, many national events have illuminated the inequities faced by the Black community in all aspects of life, including healthcare. To close the gap in healthcare equity, it is imperative that clinicians examine their practices for disparities in the treatment of minority patients and for racial injustice and take responsibility for improving any issues. As leaders in pain medicine, we can start by improving our understanding of healthcare disparities and inequities among racial and ethnic minorities and translating that knowledge into a cultural transformation to improve the care of those impacted. In this paper, we identify the areas of medicine in which pain assessment and treatment are not equitably delivered. As we acknowledge these disparities, we will highlight reasons for these incongruences in care and clarify how clinicians can act to ensure that all patients are treated equitably, with equal levels of compassion. [ABSTRACT FROM AUTHOR]

The National Cancer Institute developed the Health Disparities Calculator (HD*Calc) to facilitate research on health disparities. HD*Calc calculates multiple measures of health disparities using data collected from population-based disease surveillance systems, such as cancer registries. In this paper, we extend the use of HD*Calc to complex survey data by developing plug-in point estimators and Taylor linearization variance estimators that consider complex designs: stratification, multistage clustering, and differential weighting. Our simulation indicates that the plug-in estimators are approximately unbiased and the Taylor linearization variance estimators are accurate. Using 2011–2016 data from the National Health and Nutrition Examination Survey, we demonstrate the use of these estimators in evaluating socioeconomic disparities in the prevalence of child and adolescent (ages 2–18 years) obesity in the United States. Statistical software has been developed for ease of disparity analyses using complex survey data. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various topics within the issue, including life expectancy in the U.S. based on socioeconomic status (SES), cardiometabolic health in the U.S. and England, and the role of income in patterning health.

The article presents the discussion on evidence revealing continuous challenging gaps in the global COVID19 vaccine equity. Topics include global recognition of long-standing social inequities related to race, disability, class, caste and gender; and addressing the issue on ‘business as usual approach' encompassing COVID19 vaccines procurement.

Skin color has been proposed to contribute to race-based health disparities in the United States because of differences in ultraviolet (UV) light–induced vitamin D synthesis. The prediction of this hypothesis, herein named the UVD hypothesis, is that racial disparities in health outcomes are correlated with UV light availability. This paper investigates whether UV light availability is associated with disparities in the rates of low birth weight (LBW) and preterm birth (PTB) between whites and blacks, because these outcomes are thought to be influenced by vitamin D status and to shape disease risk in later life. Data on LBW and PTB from 2007 (n = 2,825,620 births) were compared with data on UV light exposure across the United States. Contrary to the predictions of the UVD hypothesis, LBW and PTB rate disparities were greatest in states with the highest UV light exposure. Notably, income inequality was positively and significantly related to LBW and PTB disparities, even after controlling for UV light availability. The results of this analysis demonstrate that there is a significant environmental gradient in racial disparities in birth outcomes in the United States, but other social or environmental factors associated with living in the southern United States are likely stronger contributors to disparities in birth outcomes than UV light–induced vitamin D status. [ABSTRACT FROM PUBLISHER]

A large, well-trained public health workforce is needed to control coronavirus disease 2019 (COVID-19) in the United States in the short term and to address other disease burdens and health disparities in the long run. As the public health workforce declined following the 2008 financial crisis, many US jurisdictions struggled to hire a sufficient number of staff for roles initially including testing and contact tracing and more recently for vaccination. Ultimately, COVID-19 control will require a combination of vaccination and rapid investigation, contact tracing, and quarantine to stop chains of transmission. New federal resources for a public health workforce have been made available. With appropriate attention to addressing administrative barriers and ensuring equity, a 21st-century US public health workforce will hasten the control of COVID-19, provide economic relief to individuals and communities, and reduce the burden of other infectious diseases, noncommunicable diseases, and other disease burdens. A long-term commitment to a robust public health workforce is vital to ensuring health security and preparedness for future health threats. [ABSTRACT FROM AUTHOR]

In spite of improvements in global health over the 20th century, health inequities are increasing. Mounting evidence suggests that reducing health inequities requires taking action on the social determinants of health (SDOH), which include income, education, employment, political empowerment and other factors. This paper introduces an alternative health education curriculum, developed by the US-based non-profit organization Just Health Action, which teaches critical health literacy as a step towards empowering people to achieve health equity. Critical health literacy is defined as an individual's understanding of the SDOH combined with the skills to take action at both the individual and the community level. Prior to describing our curricular framework, we connect the recommendations of the World Health Organization Commission on the SDOH with the objectives of the Ottawa Charter for Health Promotion by arguing that achieving them is reliant on critical health literacy. Then we describe our four-part curricular framework for teaching critical health literacy. Part 1, Knowledge, focuses on teaching the SDOH and the paradigm of health as a human right. Part 2, Compass, refers to activities that help students find their own direction as a social change agent. Part 3, Skills, refers to teaching specific advocacy tools and strategies. Part 4, Action, refers to the development and implementation of an action intended to increase health equity by addressing the SDOH. We describe activities that we use to motivate, engage and empower students to take action on the SDOH and provide examples of advocacy skills students have learned and actions they have implemented. [ABSTRACT FROM AUTHOR]

Objectives The prevalence of dementia varies geographically in the United States. However, the extent to which this variation reflects contemporary place-based experiences versus embodied exposures from earlier in the life course remains unclear, and little is known regarding the intersection of place and subpopulation. This study, therefore, evaluates whether and how risk for assessed dementia varies by place of residence and birth, overall and by race/ethnicity and education. Methods We pool data from the 2000 to 2016 waves of the Health and Retirement Study, a nationally representative panel survey of older U.S. adults (n  = 96,848 observations). We estimate the standardized prevalence of dementia by Census division of residence and birth. We then fit logistic regression models of dementia on region of residence and birth, adjusting for sociodemographic characteristics, and examine interactions between region and subpopulation. Results The standardized prevalence of dementia ranges from 7.1% to 13.6% by division of residence and from 6.6% to 14.7% by division of birth, with rates highest throughout the South and lowest in the Northeast and Midwest. In models accounting for region of residence, region of birth, and sociodemographic covariates, Southern birth remains significantly associated with dementia. Adverse relationships between Southern residence or birth and dementia are generally largest for Black and less-educated older adults. As a result, sociodemographic disparities in predicted probabilities of dementia are largest for those residing or born in the South. Discussion The sociospatial patterning of dementia suggests its development is a lifelong process involving cumulated and heterogeneous lived experiences embedded in place. [ABSTRACT FROM AUTHOR]

This study aimed to examine differences in mental health and alcohol use outcomes across distinct patterns of work, home, and social life disruptions associated with the COVID-19 pandemic. Data from 2093 adult participants were collected from September 2020 to April 2021 as a part of a larger study examining the impacts of the COVID-19 pandemic on substance use. Participants provided data on COVID-19 pandemic experiences, mental health outcomes, media consumption, and alcohol use at baseline. Alcohol use difficulties, including problems related to the use, desire to use alcohol, failure to cut down on alcohol use, and family/friend concern with alcohol use, were measured at 60-day follow-up. Factor mixture modeling followed by group comparisons, multiple linear regressions, and multiple logistic regressions was conducted. A four-profile model was selected. Results indicated that profile membership predicted differences in mental health and alcohol use outcomes above and beyond demographics. Individuals experiencing the most disruption reported the strongest daily impact of COVID-19 and significantly high levels of depression, anxiety, loneliness, overwhelm, alcohol use at baseline, and alcohol use difficulties measured at 60-day follow-up. The findings highlight the need for integrated mental health and/or alcohol services and social services targeting work, home, and social life during public health emergencies in order to respond effectively and comprehensively to the needs of those requiring different types of support. [ABSTRACT FROM AUTHOR]

Background and Objectives This study examined the relationship between number of attributed reasons for everyday discrimination and all-cause mortality risk, developed latent classes of discrimination attribution, and assessed whether these latent classes were related to all-cause mortality risk among U.S. older Black women. Research Design and Method Participants were from the 2006 and 2008 waves of the Health and Retirement Study (N = 1,133; 335 deaths). Vital status was collected through the National Death Index through 2013 and key informant reports through 2019. Latent class analyses were conducted on discrimination attributions. Weighted Cox proportional hazards model was used to predict all-cause mortality. Analyses controlled for demographic characteristics, socioeconomic status, and health. Results Reporting greater attributions for everyday discrimination was associated with higher mortality risk (hazard ratio [HR] = 1.117; 95% confidence interval [CI]: 1.038–1.202; p <.01), controlling for demographic characteristics, socioeconomic status, and health as well as health behaviors. A 4-class solution of the latent class analysis specified the following attribution classes: No/Low Attribution; Ancestry/Gender/Race/Age; Age/Physical Disability; High on All Attributions. When compared to the No/Low Attribution class, membership in the High on All Attributions class was associated with greater mortality risk (HR = 2.809; CI: 1.458–5.412; p <.01). Discussion and Implications Findings underscore the importance of everyday discrimination experiences from multiple sources in shaping all-cause mortality risk among older Black women. Accordingly, this study problematizes the homogenization of Black women in aging research and suggests the need for health interventions that consider Black women's multiplicity of social statuses. [ABSTRACT FROM AUTHOR]

Since about 2010, life expectancy at birth in the United States has stagnated and begun to decline, with concurrent increases in the socioeconomic divide in life expectancy. The Simulation of Alcohol Control Policies for Health Equity (SIMAH) Project uses a novel microsimulation approach to investigate the extent to which alcohol use, socioeconomic status (SES), and race/ethnicity contribute to unequal developments in US life expectancy and how alcohol control interventions could reduce such inequalities. Representative, secondary data from several sources will be integrated into one coherent, dynamic microsimulation to model life-course changes in SES and alcohol use and cause-specific mortality attributable to alcohol use by SES, race/ethnicity, age, and sex. Markov models will be used to inform transition intensities between levels of SES and drinking patterns. The model will be used to compare a baseline scenario with multiple counterfactual intervention scenarios. The preliminary results indicate that the crucial microsimulation component provides a good fit to observed demographic changes in the population, providing a robust baseline model for further simulation work. By demonstrating the feasibility of this novel approach, the SIMAH Project promises to offer superior integration of relevant empirical evidence to inform public health policy for a more equitable future. [ABSTRACT FROM AUTHOR]

Objectives Ageism is a prevalent, insidious social justice issue that has harmful effects on the health of older adults. Preliminary literature explores the intersectionality of ageism with sexism, ableism, and ageism experienced among LGBTQ+ older adults. Yet, the intersectionality of ageism with racism remains largely absent from the literature. Therefore, this study explores the lived experience of the intersectionality of ageism and racism among older adults. Methods This qualitative study applied a phenomenological approach. Twenty participants 60+ years of age (M = 69, standard deviation = 8.84) in the U.S. Mountain West identifying as Black, Latino(a), Asian–American/Pacific Islander, Indigenous, or White engaged in a 1-hr interview between February and July 2021. A 3-cycle coding process applied constant comparison methods. Five coders independently coded interviews, engaging in critical discussion to resolve disagreements. An audit trail, member checking, and peer debriefing enhanced credibility. Results This study focuses on individual-level experiences exemplified by 3 umbrella themes and 7 subthemes. The subthemes are (a) compounding oppression, (b) intersection of disparities, (c) White privilege, (d) racism and ageism: being tokenized or ignored, (e) ageism and racism: unspoken bias, (f) racism versus ageism: overt or covert? and (g) racism versus ageism: differentiated or ubiquitous? Discussion The findings indicate how ageism may be racialized through stereotypes related to mental (in)capability. Practitioners can apply the findings to enhance support for older adults by designing interventions aimed at reducing racialized ageist stereotypes and increasing collaboration through education across anti-ageism/anti-racism initiatives. Future research should focus on the impacts of the intersectionality of ageism and racism on specific health outcomes in addition to structural-level interventions. [ABSTRACT FROM AUTHOR]

Objectives The length of retirement life may be highly unequal due to persistent and significant discrepancies in old-age mortality. This study assesses gender and educational differences in the average retirement life span and the variation in retirement life span, taking into account individual labor force exit and reentry dynamics. Methods We used longitudinal data from the Health and Retirement Study from 1996 to 2016, focusing on respondents aged 50 and older (N  = 32,228). Multistate life tables were estimated using discrete-time event history models. The average retirement life span, as well as absolute and relative variation in retirement life span, were calculated analytically. Results Among women, we found a persistent educational gradient in average retirement life span over the whole period studied; among men, the relationship between education and retirement expectancy differed across periods. Women and the lower-educated had higher absolute variation in retirement life span than men and the higher-educated—yet these relationships were reversed when examined by relative variation. Discussion Our multistate approach provides an accurate and comprehensive picture of the retirement life span of older Americans over the past two decades. Such findings should be considered in high-level discussions on Social Security. Potential reforms such as raising the eligibility age or cutting benefits may have unexpected implications for different social groups due to their differential effects on retirement initiation and reentry dynamics. [ABSTRACT FROM AUTHOR]

Introduction We examined the differential impact of the 2012 Canadian GWL policy changes on key indicators of warning label impact and quit intentions using national cohorts of Canadian and U.S. adults who smoke. Aims and Methods We used data from all waves of the International Tobacco Control surveys (2002–2020) in Canada and the United States. Our key measures were quit intentions and an index of warning label effectiveness (salience, cognitive and behavioral reactions). We estimated overall policy impact by comparing Canada (treatment group) with the United States (control group) using controlled interrupted time series (CITS) regression models, with interactions to examine whether policy impact varied by sex, education, and income. Results The CITS model showed a statistically significant increase in the warning label effectiveness in Canada post-policy, compared to the United States (β = 0.84, 95% CI 0.35,1.33). Similarly, the odds of quit intentions were relatively higher among adults who smoked in Canada compared to the United States (OR = 1.89, 95% CI 1.51,2.36) post-policy. The three-way interaction model showed that these associations were greater among adults from low socioeconomic status (SES) groups than in high SES groups. Conclusions The 2012 change in the Canadian GWL policy was associated with stronger cognitive and behavioral responses to GWLs and higher odds of quit intentions among adults who smoked in Canada when compared to the United States, specifically among individuals from low SES groups, suggesting a positive equity impact. Our findings affirm the need for countries to implement or enhance GWLs, in line with the WHO Framework Convention on Tobacco Control (FCTC). Implications The evidence on the potential health equity benefit of GWL policies is mixed. To further understand the influence of GWL policies on tobacco use disparities, more systematic research using pre/post-policy designs with control groups is needed. Using a CITS model, we aimed to strengthen the available evidence on the causal influence of this tobacco control approach. Our findings show that the 2012 GWL policy change had a greater impact on adults who smoked from low SES groups than it did on adults who smoked from high SES groups, indicating a potentially positive equity impact and confirming the need for countries to implement or maximize the size of GWLs, as recommended by the WHO FCTC. [ABSTRACT FROM AUTHOR]

Despite repeated calls by scholars to critically engage with the concepts of race and ethnicity in US epidemiologic research, the incorporation of these social constructs in scholarship may be suboptimal. This study characterizes the conceptualization, operationalization, and utilization of race and ethnicity in US research published in leading journals whose publications shape discourse and norms around race, ethnicity, and health within the field of epidemiology. We systematically reviewed randomly selected articles from prominent epidemiology journals across 5 periods: 1995–1999, 2000–2004, 2005–2009, 2010–2014, and 2015–2018. All original human-subjects research conducted in the United States was eligible for review. Information on definitions, measurement, coding, and use in analysis was extracted. We reviewed 1,050 articles, including 414 (39%) in our analyses. Four studies explicitly defined race and/or ethnicity. Authors rarely made clear delineations between race and ethnicity, often adopting an ethnoracial construct. In the majority of studies across time periods, authors did not state how race and/or ethnicity was measured. Top coding schemes included "Black, White" (race), "Hispanic, non-Hispanic" (ethnicity), and "Black, White, Hispanic" (ethnoracial). Most often, race and ethnicity were deemed "not of interest" in analyses (e.g. control variables). Broadly, disciplinary practices have remained largely the same between 1995 and 2018 and are in need of improvement. [ABSTRACT FROM AUTHOR]

Social determinants of health are the economic and environmental conditions under which people are born, live, work, and age that affect health. These structural factors underlie many of the long-standing inequities in cancer care and outcomes that vary by geography, socioeconomic status, and race and ethnicity in the United States. Housing insecurity, including lack of safe, affordable, and stable housing, is a key social determinant of health that can influence—and be influenced by—cancer care across the continuum, from prevention to screening, diagnosis, treatment, and survivorship. During 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing social determinants of health, including food, housing, and transportation insecurity, and their associations with cancer care and patient outcomes. This dissemination commentary summarizes the formal presentations and panel discussions from the webinar devoted to housing insecurity. It provides an overview of housing insecurity and health care across the cancer control continuum, describes health system interventions to minimize the impact of housing insecurity on patients with cancer, and identifies challenges and opportunities for addressing housing insecurity and improving health equity. Systematically identifying and addressing housing insecurity to ensure equitable access to cancer care and reduce health disparities will require ongoing investment at the practice, systems, and broader policy levels. [ABSTRACT FROM AUTHOR]

Background and Objectives Research shows that living in segregated neighborhoods may have deleterious health outcomes via social, physical, and socioeconomic contexts that deepen existing inequities. However, there has been limited scholarship examining the effects of segregation on older adults, despite an increasing focus on aging in place. Guided by the Ecological Model of Aging, we examined the effects of segregation on older adults' self-rated health and mental health, accounting for both individual characteristics and neighborhood opportunities and risks (e.g. social cohesion) and the potential moderating role of race and economic vulnerability. Research Design and Methods We used data from the first 4 rounds of the National Health and Aging Trends Study (2011–2014) merged with tract-level census data for a final sample size of 3,084 community-dwelling older adults in urban areas. We conducted multivariate regression analyses after conditioning on residential location selection variables. Results There was no significant association between neighborhood segregation and self-rated health or between segregation and anxiety and depression symptoms. Consistent with the literature, perceived social cohesion was protective of health in each model. Discussion and Implications Our findings highlight the need for more rigorous research on segregation and older residents that utilize longitudinal and spatial data. Our findings also have implications for policies and programs that aim to support the ability to age in place for older adults who have different racial identities and live in different neighborhood contexts. Because social cohesion can be a protective factor for older adults' health and mental health, policymakers and practitioners should support initiatives to increase social cohesion. [ABSTRACT FROM AUTHOR]

Objectives To examine whether racial disparities are narrowing or widening with historical time among U.S. middle-aged and older adults, and test the extent to which educational attainment moderates racial disparities over historical time. Methods Multilevel models were applied to longitudinal data on middle-aged (ages 40–65) and older adults (ages 66 and older) from the Health and Retirement Study. Historical change was indexed as cohort or birth year. The outcomes of focus were depressive symptoms, episodic memory, health conditions, functional limitations, and self-rated health. Results Results revealed a differential pattern of racial disparities in historical change between midlife and old age. Across midlife and old age, on average, Blacks and Hispanics reported poorer levels of mental and physical health, compared with Whites. In midlife, racial disparities narrowed with historical time; later-born cohorts of Hispanics but not Whites reported fewer depressive symptoms than their earlier-born peers. Likewise, historical improvements in health were stronger among Hispanics and Blacks than Whites. Conversely, in old age, later-born cohorts across race consistently showed historical improvements in each of the outcomes examined. Regarding educational attainment, we observed little consistent evidence that health-promoting effects of educational attainment differ across race and cohort. Examining questions about heterogeneity, results revealed that in midlife and old age there was greater heterogeneity between race across each of the outcomes. Discussion Our discussion elaborates on reasons behind the documented racial differences in historical changes among U.S. middle-aged and older adults, and how the protective role of education is changing over time. [ABSTRACT FROM AUTHOR]

Objectives Discrimination is a major contributor to health disparities between Black and White older adults. Although the health effects of discrimination are well established, less is known about factors that may intervene in the discrimination–health connection, such as coping strategies. The study aim was to determine whether John Henryism (JH; high-effort coping) moderates the association between racial discrimination and hypertension in nationally representative samples of older African Americans and Caribbean Blacks. Methods The analytic sample was drawn from the National Survey of American Life—Reinterview, which was conducted 2001–2003, and included African Americans (N = 546) and Caribbean Blacks (N = 141) aged 55 and older. Study variables included racial discrimination, JH, and hypertension. Logistic regressions, which controlled key sociodemographic differences, were used to test the study aim. Results Among both Black ethnic groups, discrimination and JH were not associated with hypertension. For African Americans low and moderate in JH, discrimination was unrelated to hypertension; discrimination was positively associated with hypertension for African Americans high in JH. For Caribbean Blacks, discrimination was positively associated with hypertension among respondents low in JH. Among Caribbean Blacks moderate and high in JH, discrimination was not associated with hypertension. Discussion The findings indicate that JH, in the face of discrimination, is associated with hypertension of older African Americans but may be an effective coping strategy for older Caribbean Blacks due to cultural and sociodemographic differences between the 2 ethnic groups. Future research should investigate the differing mechanisms by which JH influences health in heterogeneous older Black populations. [ABSTRACT FROM AUTHOR]

Background While there is evidence that workers in nonstandard employment arrangements are disproportionately exposed to recognized occupational hazards, existing studies have not comprehensively examined associations between employment precarity and exposure to occupational hazards for these workers in the USA. The aim of this study was to examine relationships between employment precarity and occupational hazards in two contiguous high socio-economic hardship neighborhoods in Chicago. Methods Using a community-based participatory research approach, community researchers administered a community-developed survey to 489 residents of Greater Lawndale who reported current or recent employment in a job that met at least one characteristic of precarious employment (e.g. unpredictable schedule, insecure work, no living wage/benefits). Employment precarity was calculated using a modified version of the Employment Precarity Index (EPI) developed by the Poverty and Employment Precarity in Southern Ontario group. We modeled the association between employment precarity and occupational exposures using logistic regression models. Results We identified a high prevalence of precarious employment in this sample, as well as a high prevalence of self-reported exposure to recognized occupational hazards. Increases in relative employment precarity were significantly associated with self-reported exposure to chemical and biological hazards, physical hazards, and slip, trip, strike, fall, trap or crush hazards at work. Conclusions Results highlight the importance of using community research approaches and robust measures of employment characteristics, such as the EPI, to evaluate associations between employment precarity and hazardous exposures. These results suggest that variability in employment situations and resultant relative employment precarity are important predictors of exposure to recognized occupational hazards. Findings also suggest that health inequities observed among precariously employed workers may be partly explained by increased risk for exposure to occupational hazards, which has implications for community health and should be investigated in future longitudinal research. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Investigations of age, period, and cohort effects are difficult because the 3 factors are linearly dependent. In a novel application, Kramer et al. (Am J Epidemiol. 2015; 182(4):302-312) have used graphical analysis and statistical models to estimate the impact that age, period, and cohort effects have had on trends in black-white inequalities in heart disease mortality. Using a constrained regression approach (with the first 2 periods' effects constrained to zero), Kramer et al. find evidence that age and cohort effects figure more prominently than do period effects in contributing to relative black-white mortality differences, and they argue that early-life exposures should be given greater consideration for mitigation of racial differences in heart disease. In this invited commentary, I argue that the utility of age-period-cohort models for understanding health inequalities depends on the plausibility of the assumptions used to break the link between the 3 factors. Based on the existing age-period-cohort literature, alternative assumptions seem likely to produce substantially different results. I also argue that interpretations of the impacts of age, period, and cohort effects on racial inequalities in heart disease mortality may depend on whether inequalities are assessed on the absolute scale or the relative scale. [ABSTRACT FROM AUTHOR]

Objectives Disability in the United States has not improved in recent decades. Comparing temporal trends in disability prevalence across different income groups, both within and between the United States and England, would inform public policy aimed at reducing disparities in disability. Methods Using the Health and Retirement Study and the English Longitudinal Study of Ageing, we estimated annual percent change from 2002 to 2016 in disability among community-dwelling adults (197,021 person-years of observations). Disability was defined based on self-report of limitations with 5 instrumental activities of daily living and 6 activities of daily living. We examined the trends by age and income quintile and adjusted for individual-level sociodemographic status and survey design. Results The adjusted annual percent change (AAPC) in disability prevalence declined significantly in both countries for ages 75 and older during 2002–2016. For ages 55–64 and 65–74, disability prevalence was unchanged in the United States but declined in England. Both countries experienced a widening gap in disability between low- and high-income adults among the younger age groups. For example, for those ages 55–64 in each country, there was no significant improvement in disability for the low-income group but a significant improvement for the high-income group (AAPC = −3.60; 95% confidence interval [CI; −6.57, −0.63] for the United States; AAPC = −6.06; 95% CI [−8.77, −3.35] for England). Discussion Improvements in disability were more widespread in England than in the United States between 2002 and 2016. In both countries, the disparity in disability between low- and high-income adults widened for middle-aged adults. Policies targeted at preventing disability among low-income adults should be a priority in both countries. [ABSTRACT FROM AUTHOR]

Objectives The articles examines the contribution of internal socioeconomic disparities in mortality to the U.S. international disadvantage in life expectancy at birth. Methods Using individual death records from the U.S. national vital statistics system for years 1982–2019 and data for other countries from the Human Mortality Database, we compare age-specific death rates and life expectancy between counties classified into 10 socioeconomic categories and 20 high-income countries. We also calculate the number of years of life lost in each socioeconomic decile in relation to the comparison set. Results There is a clear and increasing socioeconomic gradient of mortality in the United States, but the growing divergence in internal mortality trends does not explain the rising gap between the country and its peers. In 2019, even American women in the most socioeconomically advantaged decile lived shorter lives, while only 10% of men in the most affluent decile fared better than their peers. The long-standing U.S. disadvantage in young adult mortality has been growing and the country's previous advantage in mortality at ages 75 years and older has virtually disappeared for all but for Americans in the most affluent counties. Discussion The similar age pattern of differences in mortality rates between each socioeconomic deciles and the comparison group suggests that the underlying factors might be the same. The role of external causes (including drug overdoses) for middle-aged adults and a slowing down in progress to control cardiovascular diseases at older ages at the national level are consistent with this pattern. [ABSTRACT FROM AUTHOR]

Objectives Since the 1980s, life expectancy at birth (e 0) in the United States has fallen steadily behind that of other high-income countries, widening the U.S. e 0 disadvantage. We estimate how that disadvantage was affected by high mortality rates in 2020, the first full year of the coronavirus disease 2019 pandemic. Methods We contrast male and female e 0 in the United States and 18 peer countries for years 1980, 1995, 2010, 2019, and 2020. Using Arriaga decomposition, we show how differences in age-specific death rates have contributed to U.S. e 0 disadvantages. Results In 2020, U.S. male and female e 0 changed by −2.33 (−2.50, −2.15) and −1.69 (−1.85, −1.53) years, respectively, whereas corresponding changes in peer countries averaged −0.67 (−0.82, −0.51) and −0.50 (−0.65, −0.35) years, respectively. This accelerated a longstanding and widening U.S. e 0 disadvantage relative to its peers, which increased from 3.49 to 5.15 years in males and from 2.78 to 3.97 years in females between 2019 and 2020. Whereas deaths before age 65 accounted for 55% and 40% of declines in U.S. male and female life expectancy, respectively, they accounted for only 24% and 11% of the respective declines in peer countries. Discussion U.S. life expectancy declines in 2020 were larger than in peer countries and involved deaths across a broader age range, particularly among young and middle-aged adults. Both the longstanding U.S. e 0 disadvantage and acute losses of life in 2020 signal the need for systemic policy changes in the United States. [ABSTRACT FROM AUTHOR]

Introduction: To analyze the impact of Truth and state-sponsored anti-tobacco media campaigns on youth smoking in the United States, and their potential to reduce tobacco-related health disparities.Aims and Methods: Our study included data from the 2000-2015 Monitoring the Future study, an annual nationally representative survey of youth in 8th (n = 201 913), 10th (n = 194 468), and 12th grades (n = 178 379). Our primary exposure was Gross Rating Points (GRPs) of Truth or state-sponsored anti-tobacco advertisements, from Nielsen Media Research. Modified Poisson regression was used to assess the impact of a respondent's GRPs on smoking intentions, past 30-day smoking participation, and first and daily smoking initiation. Additive interactions with sex, parental education, college plans, and race/ethnicity were used to test for differential effects of campaign exposure on each outcome.Results: Greater campaign exposure (80th vs. 20th GRP percentile) was associated with lower probabilities of smoking intentions among 8th graders, smoking participation among 8th and 12th graders, and initiation among 8th graders. Greater exposure was associated with a greater reduction in the likelihood of smoking participation among 10th and 12th grade males than females; 10th and 12th graders with parents of lower education versus those with a college degree; and 12th graders who did not definitely plan to go to college relative to those who did.Conclusions: Media campaign exposure was associated with a lower likelihood of youth smoking behaviors. Associations were more pronounced for groups disproportionately affected by smoking, including youth of lower socioeconomic status. Media campaigns may be useful in reducing smoking disparities and improving health equity.Implications: Few recent studies have investigated the impact of anti-tobacco media campaigns on youth smoking and their potential to reduce tobacco-related health disparities in the United States. We found media campaigns-specifically state-sponsored media campaigns-reduced the likelihood of several smoking outcomes among youth, with some evidence that they mitigate disparities for disproportionately affected groups. [ABSTRACT FROM AUTHOR]

The article presents the authors' response to Dr.S. Harper's commentary on their paper and his effort to produce complementary absolute measures. Topics discussed include the use of the age-period-cohort (APC) toolbox to examine temporal evolution of a population health disparity, pitfalls in APC analysis and underlying assumptions necessary to gain useful information and their conclusion that cohort differences contributed more to racial disparities in heart disease mortality.

In 1931, Edgar Sydenstricker, the former statistician of the US Public Health Service, challenged the common belief that the 1918 influenza outbreak had affected "the rich and the poor alike." Using data from 112,317 participants in a 1918 US national survey, he observed that, on the contrary, both morbidity and mortality from the flu had been higher among the poor than among the rich. To explain these differences, Sydenstricker stratified the analyses by 2 measures of affluence collected in the survey: "economic status" (from "very poor" to "well-to-do") and household crowding (i.e. number of people per household room). Economic status was associated with influenza attack rates within categories of crowding, but not the opposite, suggesting that characteristics of poverty other than "household congestion" were the culprit of the poor's higher influenza burden. Attack rate ratios for influenza in infants and older adults were greater for the poor or very poor. Sydenstricker reanalyzed an already 12-year-old data set in the context of the Great Depression to build the evidence base relating poverty to ill health. For this purpose he used a stratification approach to assess confounding, mediation, and interaction before the concepts were formally named. [ABSTRACT FROM AUTHOR]

With unprecedented increases, mortality trends in the United States have received significant attention in recent years. To date, research on this topic has emphasized specific causes of death and proximal behavioral or physiological determinants. In this commentary, I consider novel contributions of Zheng and Echave (Am J Epidemiol. 2021;190(11):2242–2255) in examining trends in mental health, health behaviors, and physiological dysregulation. I then discuss broader developments in related research and make a case for: 1) not allowing recent health trends among Whites to overshadow the urgent work that needs to be done to mitigate persistent racial inequities, 2) further investigation of what accounts for increases in income inequality and its life-span health consequences, and 3) broadening the scope of mechanisms considered to include underdiscussed topics such as the role of increases in social media use or environmental toxicant exposures. Underlying several potential explanations for observed trends in health and mortality is the fact that substantial change has occurred on multiple fronts in US society and that policy responses to these changes have been insufficient. An enhanced emphasis on innovative population health research will be essential to provide the evidence base needed for policy makers to rise to these urgent challenges. [ABSTRACT FROM AUTHOR]

We evaluated the association between socioeconomic status (SES) and community-associated Clostridioides difficile infection (CA-CDI) incidence across 2474 census tracts in 10 states. Highly correlated community-level SES variables were transformed into distinct factors using factor analysis. We found low SES communities were associated with higher CA-CDI incidence. [ABSTRACT FROM AUTHOR]

Background Monoclonal antibodies (mAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are a promising treatment for limiting the progression of coronavirus disease 2019 (COVID-19) and decreasing strain on hospitals. Their use, however, remains limited, particularly in disadvantaged populations. Methods Electronic health records were reviewed from SARS-CoV-2 patients at a single medical center in the United States that initiated mAb infusions in January 2021 with the support of the US Department of Health and Human Services' National Disaster Medical System. Patients who received mAbs were compared with untreated patients from the time period before mAb availability who met eligibility criteria for mAb treatment. We used logistic regression to measure the effect of mAb treatment on the risk of hospitalization or emergency department (ED) visit within 30 days of laboratory-confirmed COVID-19. Results Of 598 COVID-19 patients, 270 (45%) received bamlanivimab and 328 (55%) were untreated. Two hundred thirty-one patients (39%) were Hispanic. Among treated patients, 5/270 (1.9%) presented to the ED or required hospitalization within 30 days of a positive SARS-CoV-2 test, compared with 39/328 (12%) untreated patients (P  < .001). After adjusting for age, gender, and comorbidities, the risk of ED visit or hospitalization was 82% lower in mAb-treated patients compared with untreated patients (95% CI, 56%–94%). Conclusions In this diverse, real-world COVID-19 patient population, mAb treatment significantly decreased the risk of subsequent ED visit or hospitalization. Broader treatment with mAbs, including in disadvantaged patient populations, can decrease the burden on hospitals and should be facilitated in all populations in the United States to ensure health equity. [ABSTRACT FROM AUTHOR]

Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non‐Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. Implications for Practice: Hispanics and Latinos experience a significant and often disproportionate cancer‐related burden compared with non‐Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients. This article examines the contextual and systemic factors that contribute to and exacerbate disparities in cancer care for Hispanic and Latino cancer patients. [ABSTRACT FROM AUTHOR]

Background Adherence to healthy lifestyles/behaviours promotes healthy ageing. However, little is known about whether age, sex and/or race/ethnicity moderate associations of lifestyle/behavioural factors with relative telomere length (RTL), a potential biomarker of ageing. Methods We included 749 midlife to older non-Hispanic White (n  = 254), Black (n  = 248) and Hispanic (n  = 247) US participants [mean (standard deviation) age = 69.3 (7.2) years; women: 50.5%]. We extracted genomic DNA from peripheral leucocytes. RTL was assayed using real-time quantitative polymerase chain reaction. Multivariable regression was used to examine associations between lifestyle/behavioural exposures (i.e. physical activity, alcohol consumption, smoking and depression) with RTL. Results Increasing chronological age was associated with shorter RTL (P  < 0.01). Higher physical activity was associated with longer RTL (P -trend = 0.03); daily versus never/rare alcohol consumption and 30+ versus <5 smoking pack-year were associated with shorter RTLs (P -trend = 0.02). Associations varied significantly by sex and race/ethnicity. The association between physical activity and longer RTL appeared strongest among non-Hispanic Whites (P -interaction = 0.01). Compared to men, women had stronger associations between heavy smoking and shorter RTLs (P -interaction = 0.03). Light/moderate alcohol consumption (monthly/weekly) was associated with longer RTL among non-Hispanic Whites, while daily consumption was related to shorter RTLs among Blacks and Hispanics (P -interactions < 0.01). Associations of daily alcohol and heavy smoking with shorter RTLs were particularly apparent among Black women. Conclusion We observed novel variations by sex and race/ethnicity in associations between lifestyle/behavioural factors and RTL. Further work is needed to replicate these findings and to address potential public health implications for modifying strategies by sex or across racial/ethnic groups to optimise lifestyles/behaviours for healthy ageing. [ABSTRACT FROM AUTHOR]

Objectives Hearing impairment is one of the most common disabilities among older people, and its prevalence will increase as the U.S. population ages. However, little is known about social disparities in onset or transitions into and out of hearing impairment, nor how these transitions impact years of life to be spent impaired. Method We investigate the number of years an "average" person can expect to live with and without hearing impairment after age 50; sex, race, educational, and regional differences in these expectancies; and the implication of hearing impairment for remaining life expectancy. Bayesian multistate life table methods are applied to 9 waves of data from the Health and Retirement Study (1998–2014) to investigate social disparities in life expectancy with hearing impairment (n = 20,200) for the general population, people hearing impaired at age 50, and people hearing unimpaired at age 50. Results Men, Hispanics, persons with less educational attainment, and those born in the south can expect to live a larger proportion of their remaining lives hearing impaired. Although transitions from hearing impaired to unimpaired occur, those with some hearing impairment at age 50 can expect to live more years with hearing impairment, and hearing impairment does not shorten remaining life expectancy. Discussion Significant sociodemographic disparities in hearing impaired life expectancy exist. In contrast to past research, we find that hearing impairment does not affect total life expectancy. Future research should consider the consequences of hearing impairment for years to be lived with other age-related and potentially downstream health outcomes. [ABSTRACT FROM AUTHOR]

Background: Rates of sexually transmitted infections (STI) have risen steadily in recent years, and racial and ethnic minorities have borne the disproportionate burden of STI increases in the United States. Historical inequities and social determinants of health are significant contributors to observed disparities and affect access to diagnostic testing for STI. Content: Public health systems rely heavily on laboratory medicine professionals for diagnosis and reporting of STI. Therefore, it is imperative that clinicians and laboratory professionals be familiar with issues underlying disparities in STI incidence and barriers to reliable diagnostic testing. In this mini-review, we will summarize contributors to racial/ethnic disparity in STI, highlight current epidemiologic trends for gonorrhea, chlamydia, and syphilis, discuss policy issues that affect laboratory and public health funding, and identify specific analytic challenges for diagnostic laboratories. Summary: Racial and ethnic disparities in STI in the US are striking and are due to complex interactions of myriad social determinants of health. Budgetary cuts for laboratory and public health services and competition for resources during the COVID-19 pandemic are major challenges. Laboratory professionals must be aware of these underlying issues and work to maximize efforts to ensure equitable access to diagnostic STI testing for all persons, particularly those most disproportionately burdened by STI. [ABSTRACT FROM AUTHOR]

The authors respond to a commentary that called for improvement of measures to counter health disparities in African American and White people conditioned by social capital resources. They recognize the absence of literature that allows measurement of racial differences in relation to social capital and tools to measure health inequalities between races. They call for involvement of ethnic minority groups in questionnaire development and expansion of operationalization of social capital.

Background and Objectives Racial disparities in health and socioeconomic characteristics of older adults have implications for the experiences of their family and unpaid caregivers, but knowledge to date has primarily drawn from convenience samples. Using a population-based sample, we examine associations between caregiver race and caregiving-related effects. Research Design and Methods Study participants include white (n = 992) and black (n = 556) respondents to the 2015 National Study of Caregiving who assisted community-dwelling older adults with disabilities who participated in the National Health and Aging Trends Study. Guided by Pearlin's Stress Process Model, hierarchical logistic regression models were constructed to examine race differences in caregiving-related effects after adjusting for caregiving context, stressors, and resources. Results Relative to white caregivers, blacks more often provided in excess of 40 hr of care per week (54.3% vs 38.6%) and more often cared for an older adult with dementia (27.1% vs 20.7%) who was living below the federal poverty line (31.7% vs 11.9%) or was Medicaid-eligible (42.2% vs 11.8%). Black caregivers more often used supportive services (32.9% vs 24.8%). In fully adjusted regression models, black caregivers were more likely to report gains and less likely to report emotional difficulty than whites. Service utilization did not attenuate caregiving-related emotional difficulty or participation restrictions, regardless of race. Discussion and Implications Findings highlight caregiving disparities and counterintuitive differences in experiences and indicate the importance of identifying supports such as paid family leave and faith and community-based programming to better support community-dwelling low-income older adults and their family and unpaid caregivers. [ABSTRACT FROM AUTHOR]

The authors reflect on the practice, research and policy strategies in social work in the U.S. to help resolve extreme economic inequality. Also cited are the American Academy of Social Work and Social Welfare's (AASWSW) Grand Challenges for Social Work urging social workers to resolve societal issues, the efforts by social reform pioneers like Harry Hopkins and Frances Perkins to resolve economic injustice, and the key role played by social work researchers in advancing workers' welfare.

Background: Obesity (OB) is a serious epidemic in the United States.Methods: We examined OB patterns and time trends across socio-economic and geographic parameters and projected the future situation. Large national databases were used. Overweight (OW), OB and severe obesity (SOB) were defined using body mass index cut-points/percentiles; central obesity (CO), waist circumference cut-point in adults and waist:height ratio cutoff in youth. Various meta-regression analysis models were fit for projection analyses.Results: OB prevalence had consistently risen since 1999 and considerable differences existed across groups and regions. Among adults, men's OB (33.7%) and OW (71.6%) levelled off in 2009-2012, resuming the increase to 38.0 and 74.7% in 2015-2016, respectively. Women showed an uninterrupted increase in OB/OW prevalence since 1999, reaching 41.5% (OB) and 68.9% (OW) in 2015-2016. SOB levelled off in 2013-2016 (men: 5.5-5.6%; women: 9.7-9.5%), after annual increases of 0.2% between 1999 and 2012. Non-Hispanic Blacks had the highest prevalence in women's OB/SOB and men's SOB. OB prevalence in boys rose continuously to 20.6% and SOB to 7.5% in 2015-2016, but not in girls. By 2030, most Americans will be OB/OW and nearly 50% of adults OB, whereas ∼33% of children aged 6-11 and ∼50% of adolescents aged 12-19 will be OB/OW. Since 1999, CO has risen steadily, and by 2030 is projected to reach 55.6% in men, 80.0% in women, 47.6% among girls and 38.9% among boys. Regional differences exist in adult OB prevalence (2011-2016) and across ethnicities; South (32.0%) and Midwest (31.4%) had the highest rates.Conclusions: US obesity prevalence has been rising, despite a temporary pause in 2009-2012. Wide disparities across groups and geographical regions persist. Effective, sustainable, culturally-tailored interventions are needed. [ABSTRACT FROM AUTHOR]

Objectives Research on the socioeconomic gradient in mental health links disadvantaged family background with subsequent symptoms of depression, demonstrating the "downstream" effect of parental resources on children's mental health. This study takes a different approach by evaluating the "upstream" influence of adult children's educational attainment on parents' depressive symptoms. Methods Using longitudinal data from the U.S. Health and Retirement Study (N = 106,517 person-years), we examine whether children's college attainment influences their parents' mental health in later life and whether this association increases with parental age. We also assess whether the link between children's college completion and parents' depression differs by parents' own education. Results Parents with children who completed college have significantly lower levels of depressive symptoms than parents without college-educated children, although the gap between parents narrows with age. In addition, at baseline, parents with less than a high school education were more positively affected by their children's college completion than parents who themselves had a college education, a finding which lends support to theories of resource substitution. Discussion Offspring education is an overlooked resource that can contribute to mental health disparities among older adults in a country with unequal access to college educations. [ABSTRACT FROM AUTHOR]

Improvements in life expectancy among people living with human immunodeficiency virus (PLWH) receiving antiretroviral treatment in the United States and Canada might differ among key populations. Given the difference in substance use among key populations and the current opioid epidemic, drug- and alcohol-related deaths might be contributing to the disparities in life expectancy. We sought to estimate life expectancy at age 20 years in key populations (and their comparison groups) in 3 time periods (2004–2007, 2008–2011, and 2012–2015) and the potential increase in expected life expectancy with a simulated 20% reduction in drug- and alcohol-related deaths using the novel Lives Saved Simulation model. Among 92,289 PLWH, life expectancy increased in all key populations and comparison groups from 2004–2007 to 2012–2015. Disparities in survival of approximately a decade persisted among black versus white men who have sex with men and people with (vs. without) a history of injection drug use. A 20% reduction in drug- and alcohol-related mortality would have the greatest life-expectancy benefit for black men who have sex with men, white women, and people with a history of injection drug use. Our findings suggest that preventing drug- and alcohol-related deaths among PLWH could narrow disparities in life expectancy among some key populations, but other causes of death must be addressed to further narrow the disparities. [ABSTRACT FROM AUTHOR]

Public health scholars and policy-makers are concerned that the United States continues to experience unmanageable health care costs while struggling with issues surrounding access and equity. To addresses these and other key issues, the National Academy of Medicine held a public symposium, Vital Directions for Health and Health Care: A National Conversation during September 2016, with the goal of identifying clear priorities for high-value health care and improved well-being. One important area was addressing social determinants of health. This article contributes to this objective by investigating the impact of wealth on older Black women's health. Employing the 2008/2010 waves of the RAND Health and Retirement Study on a sample of 906 older Black women, this panel study examined self-assessed health ratings of very good/good/fair/poor within a relaxed random effects framework, thereby controlling for both (i) observed and (ii) unobserved individual-level heterogeneity. This analysis did not find a statistically significant association with wealth despite a difference of approximately $75 000 in its valuation from very good to poor health. This also occurred after wealth was (i) readjusted for outliers and (ii) reformulated as negative, no change or positive change from 2008. This finding suggests that wealth may not play as integral a role. However, the outcome was significant for earnings and education, particularly higher levels of education. Scholars should further this inquiry to better understand how earnings/education/wealth operate as social determinants of health for minority populations. [ABSTRACT FROM AUTHOR]

Objectives To examine the socioeconomic status (SES) health gradient for obesity, diabetes, and hypertension within a diverse group of health outcomes and behaviors among older adults (60+) in upper middle-income countries benchmarked with high-income countries. Method We used data from three upper middle-income settings (Colombia-SABE-Bogotá, Mexico-SAGE, and South Africa-SAGE) and two high-income countries (England-ELSA and US-HRS) to estimate logistic regression models using age, gender, and education to predict health and health behaviors. Results The sharpest gradients appear in middle-income settings but follow expected patterns found in high-income countries for poor self-reported health, functionality, cognitive impairment, and depression. However, weaker gradients appear for obesity, hypertension, diabetes, and other chronic conditions in Colombia and Mexico and the gradient reverses in South Africa. Strong disparities exist in risky health behaviors and in early nutritional status in the middle-income settings. Discussion Rapid demographic and nutritional transitions, urbanization, poor early life conditions, social mobility, negative health behavior, and unique country circumstances provide a useful framework for understanding the SES health gradient in middle-income settings. In contrast with high-income countries, the increasing prevalence of obesity, an important risk factor for chronic conditions and other aspects of health, may ultimately change the SES gradient for diseases in the future. [ABSTRACT FROM AUTHOR]