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Reproductive health outcomes are indicators of larger social processes and researchers have long documented inequalities in these outcomes among Blacks and Whites in the United States. However, we do not fully understand the underlying mechanisms responsible for these inequalities. We believe that this is partially due to the treatment of the Black population as a monolith, which masks underlying variation in health risks and outcomes. By examining the variation that exists beneath the average, we can begin to develop a better understanding of the potential sources of health inequalities between Blacks and other racialized populations. We provide an application of this perspective through a geographic examination of reproductive health outcomes within the Black population. Using national birth records data from 2013 to 2016, we examine differences in low birth weight, preterm birth, gestational hypertension, and gestational diabetes by nativity (i.e., US- or foreign-born), region of origin (e.g., Sub-Saharan Africa, the Caribbean), and current US division of residence (e.g., Middle Atlantic, South Atlantic) within the Black population. While foreign-born Blacks are at a lower risk for low birth weight, preterm birth, and gestational hypertension, they are at an elevated risk for gestational diabetes compared to US-born Blacks. Moreover, we find substantial variation in this general pattern across region of origin and division of residence in the US. These findings demonstrate the potential role of migration, context, and selectivity in the health of foreign-born Blacks and demonstrate that national averages mask geographic variation, limiting our understanding of the contributions of these and other social processes to the health of racialized groups in the US.

We use data on police-involved deaths to estimate how the risk of being killed by police use of force in the United States varies across social groups. We estimate the lifetime and age-specific risks of being killed by police by race and sex. We also provide estimates of the proportion of all deaths accounted for by police use of force. We find that African American men and women, American Indian/Alaska Native men and women, and Latino men face higher lifetime risk of being killed by police than do their white peers. We find that Latina women and Asian/Pacific Islander men and women face lower risk of being killed by police than do their white peers. Risk is highest for black men, who (at current levels of risk) face about a 1 in 1,000 chance of being killed by police over the life course. The average lifetime odds of being killed by police are about 1 in 2,000 for men and about 1 in 33,000 for women. Risk peaks between the ages of 20 y and 35 y for all groups. For young men of color, police use of force is among the leading causes of death.

Key Points Question Is the incarceration of a family member associated with well-being and projected life expectancy? Findings In this cross-sectional study including 2815 individuals, any family member incarceration was associated with lower well-being and a projected 2.6-year reduction in life expectancy compared with no family member incarceration experience. Among those with any family incarceration, Black respondents had an estimated 0.5 fewer years of projected life expectancy compared with White respondents. Meaning These findings suggest that efforts to decarcerate may improve population-level health and well-being by reducing racial disparities and detrimental outcomes associated with incarceration for nonincarcerated family members., This cross-sectional study assesses the associations of incarceration of a family member with perceived well-being and projected life expectancy among adults in the US., Importance More than half of the adult population in the United States has ever had a family member incarcerated, an experience more common among Black individuals. The impacts of family incarceration on well-being are not fully understood. Objective To assess the associations of incarceration of a family member with perceived well-being and differences in projected life expectancy. Design, Setting, and Participants This nationally representative cross-sectional study used data from the 2018 Family History of Incarceration Survey to examine how experiences of family member incarceration were associated with a holistic measure of well-being, including physical, mental, social, financial, and spiritual domains. Well-being was used to estimate change in life expectancy and was compared across varying levels of exposure to immediate and extended family member incarceration using logistic regression models to adjust for individual and household characteristics. Data were analyzed from October 2019 to April 2020. Exposures Respondents’ history of family member incarceration, including immediate and extended family members. Main Outcomes and Measures The main outcome was self-reported life-evaluation, a measure of overall well-being from the 100 Million Healthier Lives Adult Well-being Assessment. Respondents were considered thriving with a current life satisfaction score of 7 or greater and a future life optimism score of 8 or greater, each on a scale of 0 to 10. Other outcomes included physical health, mental health, social support, financial well-being, and spiritual well-being, each measured with separate scales. Additionally, life expectancy projections were estimated using population-level correlations with the Life Evaluation Index. All percentages were weighted to more closely represent the US population. Results Of 2815 individuals included in analysis, 1472 (51.7%) were women, 1765 (62.8%) were non-Hispanic White, and 868 (31.5%) were aged 35 to 54 years. A total of 1806 respondents (45.0%) reported having an immediate family member who was incarcerated. Compared with respondents with no family incarceration, any family member incarceration was associated with lower well-being overall (thriving: 69.5% [95% CI, 65.0%-75.0%] vs 56.9% [95% CI, 53.9%-59.9%]) and in every individual domain (eg, physical thriving: 51.1% [95% CI, 46.2-56.0] vs 35.5% [95% CI, 32.6%-38.3%]) and with a mean (SE) estimated 2.6 (0.03) years shorter life expectancy. Among those with any family incarceration, Black respondents had a mean (SE) estimated 0.46 (0.04) fewer years of life expectancy compared with White respondents. Conclusions and Relevance These findings suggest that family member health and well-being may be an important avenue through which incarceration is associated with racial disparities in health and mortality. Decarceration efforts may improve population-level well-being and life expectancy by minimizing detrimental outcomes associated with incarceration among nonincarcerated family members.

A growing body of research highlights the collateral consequences of mass incarceration, including stop-and-frisk policing tactics. Living in a neighborhood with aggressive policing may affect one's mental health, especially for men who are the primary targets of police stops. We examine whether there is an association between psychological distress and neighborhood-level aggressive policing (i.e., frisking and use of force by police) and whether that association varies by gender. The 2009-2011 New York City (NYC) Stop, Question, and Frisk Database is aggregated to the neighborhood-level (N = 34) and merged with individual data from the 2012 NYC Community Health Survey (N = 8066) via the United Hospital Fund neighborhood of respondents' residence. Weighted multilevel generalized linear models are used to assess main and gendered associations of neighborhood exposures to aggressive police stops on psychological distress (Kessler-6 items). While the neighborhood stop rate exhibits inconsistent associations with psychological distress, neighborhood-level frisk and use of force proportions are linked to higher levels of non-specific psychological distress among men, but not women. Specifically, men exhibit more non-specific psychological distress and more severe feelings of nervousness, effort, and worthlessness in aggressively surveilled neighborhoods than do women. Male residents are affected by the escalation of stop-and-frisk policing in a neighborhood. Living in a context of aggressive policing is an important risk factor for men's mental health.

The digital traces that we leave online are increasingly fruitful sources of data for social scientists, including those interested in demographic research. The collection and use of digital data also presents numerous statistical, computational, and ethical challenges, motivating the development of new research approaches to address these burgeoning issues. In this article, we argue that researchers with formal training in demography—those who have a history of developing innovative approaches to using challenging data—are well positioned to contribute to this area of work. We discuss the benefits and challenges of using digital trace data for social and demographic research, and we review examples of current demographic literature that creatively use digital trace data to study processes related to fertility, mortality, and migration. Focusing on Facebook data for advertisers—a novel “digital census” that has largely been untapped by demographers—we provide illustrative and empirical examples of how demographic researchers can manage issues such as bias and representation when using digital trace data. We conclude by offering our perspective on the road ahead regarding demography and its role in the data revolution.

Objectives Since the 1980s, older, low-educated White women experienced an unprecedented decrease in life expectancy. We investigated whether a similar phenomenon was evident among younger women for obesity. Methods Using the National Health and Nutrition Examination Survey, age-adjusted changes were estimated in the prevalence of overall and abdominal obesity (BMI ≥ 30 kg/m2, waist circumference > 88 cm) between 1988-1994 and 2003-2010 among non-Hispanic White women aged 25-44 years, stratified by educational attainment (

Objectives. We examined the relationship between timing of poverty and risk of first-incidence obesity from ages 3 to 15.5 years. Methods. We used the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (1991–2007) to study 1150 children with repeated measures of income, weight, and height from birth to 15.5 years in 10 US cities. Our dependent variable was the first incidence of obesity (body mass index ≥ 95th percentile). We measured poverty (income-to-needs ratio Results. Poverty prior to age 2 years was associated with risk of obesity by age 15.5 years in fully adjusted models. These associations did not vary by gender. Conclusions. Our findings suggest that there are enduring associations between early life poverty and adolescent obesity. This stage in the life course may serve as a critical period for both poverty and obesity prevention.

Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. We analyzed 2006-2010 data from the Pregnancy Risk Assessment and Monitoring System to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Women reporting incarceration of themselves or their partners in the year before birth of a child had .86 the odds (95 % CI .78-.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the US simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development.

Objectives. We investigated the association between anticipatory stress, also known as racism-related vigilance, and hypertension prevalence in Black, Hispanic, and White adults. Methods. We used data from the Chicago Community Adult Health Study, a population-representative sample of adults (n = 3105) surveyed in 2001 to 2003, to regress hypertension prevalence on the interaction between race/ethnicity and vigilance in logit models. Results. Blacks reported the highest vigilance levels. For Blacks, each unit increase in vigilance (range = 0–12) was associated with a 4% increase in the odds of hypertension (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 1.00, 1.09). Hispanics showed a similar but nonsignificant association (OR = 1.05; 95% CI = 0.99, 1.12), and Whites showed no association (OR = 0.95; 95% CI = 0.87, 1.03). Conclusions. Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites; it is a possible contributor to hypertension among Hispanics but not Whites.

Political participation and citizens’ perceptions of the legitimacy and fairness of government are central components of democracy. In this article, we examine one possible threat to these markers of a just political system: family member incarceration. We offer a unique glimpse into the broader social consequences of punishment that are brought on by a partner’s or parent’s incarceration. We argue that the criminal justice system serves as an important institution for political socialization for the families of those imprisoned, affecting their attitudes and orientations toward the government and their will and capacity to become involved in political life. We draw from ethnographic data collected by one of the authors, quantitative data from the National Longitudinal Study of Adolescent Health, and interviews with recently released male prisoners and their female partners. Our findings suggest that experiences of a family member’s incarceration complicate perceptions of government legitimacy and fairness and serve as a barrier to civic participation.

Objective Research conducted on school-based interventions suggests that school connectedness protects against a variety of risk behaviors, including substance abuse, delinquency and sedentary behavior. The line of research is extended by examining the link between college expectations and early adult weight gain using nationally representative panel data from thirty cohorts of American high school seniors followed prospectively to age 30 in the Monitoring the Future Study (1986-2009). Design and Methods Growth mixture models identified two latent classes of trajectories of body mass index (BMI) from age 19 to 30: a persistently overweight class (BMI ≥ 25) and a second class exhibiting more moderate growth in BMI to age 30. Results Compared to those who did not expect to graduate from college, students fully expecting to graduate from college had 34% lower odds of being in the persistently overweight class (adjusted odds ratio = 0.66, 95% confidence interval = 0.54, 0.81), controlling for academic performance and socioeconomic status. Conclusions Successful prevention of obesity early in the life course is based on a multifactorial approach incorporating strategies that address the contexts in which adolescents are embedded. The school setting may be one avenue where successful educational attachment could have positive consequences for subsequent weight gain in early adulthood.

It is generally accepted that obesity and depression are positively related in women. Very little prior research, however, has examined potential variation in this relationship across different racial/ethnic groups. This paper examines the association between obesity and depression in non-Hispanic White, non-Hispanic Black, and Mexican American women.The sample included women aged 20 years and older in the 2005-2008 National Health and Nutrition Examination Surveys (n=3666). Logistic regression was used to assess the relationship between obesity and depression syndrome (assessed using the Patient Health Questionnaire-9), after adjusting for covariates. We then investigated whether this association varied by race/ethnicity.Overall, obese women showed a 73% greater odds of depression (odds ratio [OR]=1.73; 95% confidence interval [CI]=1.19, 2.53) compared with normal weight women. This association varied significantly, however, by race/ethnicity. The obesity-depression associations for both Black and Mexican American women were different from the positive association found for White women (ORBlack*obese=0.24; 95% CI=0.10,0.54; ORMexican American*obese=0.42; 95% CI=1.04). Among White women, obesity was associated with significantly greater likelihood of depression (OR=2.37; 95% CI=1.41, 4.00) compared to normal weight. Among Black women, although not statistically significant, results are suggestive that obesity was inversely associated with depression (OR=0.56; 95% CI=0.28, 1.12) relative to normal weight. Among Mexican American women, obesity was not associated with depression (OR=1.01; 95% CI=0.59, 1.72).The results reveal that the association between obesity and depression varies by racial/ethnic categorization. White, but not Black or Mexican American women showed a positive association. Next research steps could include examination of factors that vary by race/ethnicity that may link obesity to depression.

Objectives. Consistent findings show that black Americans have high rates of cardiovascular disease (CVD) and related behavioral risk factors. Despite this body of work, studies on black Americans are generally limited to the 50 U.S. states. We examined variation in CVD and related risk factors among black Americans by comparing those residing within the U.S. Virgin Islands (USVI) with those residing in the 50 U.S. states and Washington, D.C. (US 50/DC) and residing in different regions of the US 50/DC (Northeast, Midwest, South, and West). Methods. Using data from the 2007 and 2009 Behavioral Risk Factor Surveillance System, we compared CVD and CVD risk factor prevalence in non-Hispanic black people (≥20 years of age) in the USVI and US 50/DC, examining the relative contributions of health behaviors, health insurance, and socioeconomic status (SES). Results. Accounting for age, sex, education, health insurance, and health behaviors, US 50/DC black Americans were significantly more likely than USVI black people to report ever having a stroke and coronary heart disease, and to be hypertensive, diabetic, or obese While there was heterogeneity by region, similar patterns emerged when comparing the USVI with different regions of the US 50/DC. Conclusion. USVI black people have lower CVD and risk factor prevalence than US 50/DC black people. These lower rates are not explained by differences in health behaviors or SES. Understanding health in this population may provide important information on the etiology of racial/ethnic variation in health in the U.S. and elsewhere, and highlight relevant public health policies to reduce racial/ethnic group disparities.

Racial/ethnic disparities in adolescent obesity in the U.S. are stark, and the causes of these disparities are largely unknown. We used a cumulative risk index (CRI) to examine the role of social risk in racial/ethnic disparities in obesity. Using the National Longitudinal Study of Adolescent Health and multinomial logistic regression, we examined the role of this CRI in disparities in obesity in the transition from adolescence to adulthood. Controlling for sociodemographic characteristics, compared with White females, Black and Hispanic females had roughly a 50% increase in the odds of newly-developed obesity in adulthood and a 90% increase in the odds of persistent obesity in adolescence and adulthood. After adding our CRI, the Black-White disparities were attenuated to statistical non-significance. Hispanic-White disparities did not change. There were no disparities in obesity for males. Our results suggest that social risk factors accumulate to explain Black-White disparities in obesity for females.

To examine the association between clinically identified and undiagnosed prediabetes and Type 2 diabetes with depression and antidepressant medication use.Data come from the National Health and Nutrition Examination Study (2005 and 2007), a population-based cross-sectional survey. Analysis is limited to adults aged 30 and older (n = 3,183, Mean age = 52.1 year). Depression syndrome was measured by the Patient Health Questionnaire-9. Participants were categorized using fasting glucose levels as normoglycemic (glucose100 mg/dL), undiagnosed prediabetes (glucose 100-125.9), clinically identified prediabetes (glucose 100-125.9 plus clinician diagnosis), undiagnosed Type 2 diabetes (glucose126), and clinically identified Type 2 diabetes (glucose126 plus clinician diagnosis or use of antidiabetic medications). Health behaviors included smoking, poor diet, excessive alcohol use, and obesity. Health promotion behaviors included efforts to change diet, lose weight, and increase physical activity.Clinically identified diabetes was associated with 4.3-fold greater odds of depression, but undiagnosed diabetes was not significantly associated with depression. This relationship was more pronounced for prediabetes. Clinically identified diabetes was associated with 1.8-fold greater odds of antidepressant use, but undiagnosed diabetes was not significantly associated with antidepressant use. Health behaviors were not consistently related to depression syndrome.The relationship between diabetes status and depression and antidepressant use depends on whether the diabetes has been clinically identified. Findings are consistent with the hypothesis that the relationship between diabetes and depression may be attributable to factors related to disease management. Previous reports linking antidepressants and diabetes may be attributable to clinical ascertainment bias.

Objectives. Human papillomavirus (HPV) is a common sexually transmitted infection in the United States, yet HPV vaccination rates remain relatively low. We examined racial/ethnic differences in the prevalence of health care provider recommendations for HPV vaccination and the association between recommendation and vaccination. Methods. We used the 2009 National Immunization Survey–Teen, a nationally representative cross-section of female adolescents aged 13 to 17 years, to assess provider-verified HPV vaccination (≥ 1 dose) and participant-reported health care provider recommendation for the HPV vaccine. Results. More than half (56.9%) of female adolescents received a recommendation for the HPV vaccine, and adolescents with a recommendation were almost 5 times as likely to receive a vaccine (odds ratio = 4.81; 95% confidence interval = 4.01, 5.77) as those without a recommendation. Racial/ethnic minorities were less likely to receive a recommendation, but the association between recommendation and vaccination appeared strong for all racial/ethnic groups. Conclusions. Provider recommendations were strongly associated with HPV vaccination. Racial/ethnic minorities and non-Hispanic Whites were equally likely to obtain an HPV vaccine after receiving a recommendation. Vaccine education efforts should target health care providers to increase recommendations, particularly among racial/ethnic minority populations.

A number of high-profile incidents have highlighted tensions between citizens and police, bringing issues of police-citizen trust and community policing to the forefront of the public’s attention. Efforts to mediate this tension emphasize the importance of promoting interaction and developing social relationships between citizens and police. This strategy – a critical component of community policing – may be employed in a variety of settings, including social media. While the use of social media as a community policing tool has gained attention from precincts and law enforcement oversight bodies, the ways in which police are expected to use social media to meet these goals remains an open question. This study seeks to explore how police are currently using social media as a community policing tool. It focuses on Twitter – a functionally flexible social media space – and considers whether and how law enforcement agencies are co-negotiating norms of engagement within this space, as well as how the public responds to the behavior of police accounts.

Purpose This study examined trends in body mass index (BMI) during the transition from adolescence to young adulthood by gender and race, using national data from the United States spanning for >40 years from 1959 and 2002. Although past research has investigated BMI trends separately in childhood/adolescence and adulthood, this study uniquely focused on the transition to adulthood (12–26 years) to identify the emergence of the obesity epidemic during this critical life-stage. Methods Longitudinal and cross-sectional data were obtained from four nationally representative surveys: National Health and Nutrition Examination Survey, National Longitudinal Study of Adolescent Health, National Health Interview Survey, and National Longitudinal Surveys of Youth (NLSY79 and NLSY97). The analysis tracked age trends in BMI by time, which allowed for the examination of how BMI changed during the transition to adulthood and whether the patterns of change varied by period. Data best suited for trend analysis were identified. Age trends in BMI by gender and race were graphed and regression analysis was used to test for significant differences in the trends using the National Health and Nutrition Examination Survey and National Longitudinal Study of Adolescent Health. Results BMI increased sharply in the adolescent ages, beginning in the 1990s and among young adults around 2000. This age pattern of BMI increase was more dramatic among females and blacks, particularly black females. Conclusions BMI increased during the transition to adulthood and these increases have grown larger over time. Obesity prevention efforts should focus on this high-risk transition period, particularly among minority populations.

Despite recent and growing interest in using Twitter to examine human behavior and attitudes, there is still significant room for growth regarding the ability to leverage Twitter data for social science research. In particular, gleaning demographic information about Twitter users—a key component of much social science research—remains a challenge. This article develops an accurate and reliable data processing approach for social science researchers interested in using Twitter data to examine behaviors and attitudes, as well as the demographic characteristics of the populations expressing or engaging in them. Using information gathered from Twitter users who state an intention to not vote in the 2012 presidential election, we describe and evaluate a method for processing data to retrieve demographic information reported by users that is not encoded as text (e.g., details of images) and evaluate the reliability of these techniques. We end by assessing the challenges of this data collection strategy and discussing how large-scale social media data may benefit demographic researchers.

IMPORTANCE Child maltreatment is a risk factor for poor health throughout the life course. Existing estimates of the proportion of the US population maltreated during childhood are based on retrospective self-reports. Records of officially confirmed maltreatment have been used to produce annual rather than cumulative counts of maltreated individuals. OBJECTIVE To estimate the proportion of US children with a report of maltreatment (abuse or neglect) that was indicated or substantiated by Child Protective Services (referred to as confirmed maltreatment) by 18 years of age. DESIGN, SETTING, AND PARTICIPANTS The National Child Abuse and Neglect Data System (NCANDS) Child File includes information on all US children with a confirmed report of maltreatment, totaling 5 689 900 children (2004-2011). We developed synthetic cohort life tables to estimate the cumulative prevalence of confirmed childhood maltreatment by 18 years of age. MAIN OUTCOMES AND MEASURES The cumulative prevalence of confirmed child maltreatment by race/ethnicity, sex, and year. RESULTS At 2011 rates, 12.5% (95% CI, 12.5%-12.6%) of US children will experience a confirmed case of maltreatment by 18 years of age. Girls have a higher cumulative prevalence (13.0% [95% CI, 12.9%-13.0%]) than boys (12.0% [12.0%-12.1%]). Black (20.9% [95% CI, 20.8%-21.1%]), Native American (14.5% [14.2%-14.9%]), and Hispanic (13.0% [12.9%-13.1%]) children have higher prevalences than white (10.7% [10.6%-10.8%]) or Asian/Pacific Islander (3.8% [3.7%-3.8%]) children. The risk for maltreatment is highest in the first few years of life; 2.1% (95% CI, 2.1%-2.1%) of children have confirmed maltreatment by 1 year of age, and 5.8% (5.8%-5.9%), by 5 years of age. Estimates from 2011 were consistent with those from 2004 through 2010. CONCLUSIONS AND RELEVANCE Annual rates of confirmed child maltreatment dramatically understate the cumulative number of children confirmed to be maltreated during childhood. Our findings indicate that maltreatment will be confirmed for 1 in 8 US children by 18 years of age, far greater than the 1 in 100 children whose maltreatment is confirmed annually. For black children, the cumulative prevalence is 1 in 5; for Native American children, 1 in 7. Language: en

Objectives. We examined the association of family member incarceration with cardiovascular risk factors and disease by gender. Methods. We used a sample of 5470 adults aged 18 years and older in the National Survey of American Life, a 2001–2003 nationally representative cross-sectional survey of Blacks and Whites living in the United States, to examine 5 self-reported health conditions (diabetes, hypertension, heart attack or stroke, obesity, and fair or poor health). Results. Family member incarceration was associated with increased likelihood of poor health across all 5 conditions for women but not for men. In adjusted models, women with family members who were currently incarcerated had 1.44 (95% confidence interval [CI] = 1.03, 2.00), 2.53 (95% CI = 1.80, 3.55), and 1.93 (95% CI = 1.45, 2.58) times the odds of being obese, having had a heart attack or stroke, and being in fair or poor health, respectively. Conclusions. Family member incarceration has profound implications for women’s cardiovascular health and should be considered a unique risk factor that contributes to racial disparities in health.

Objectives. We used Danish registry data to examine the association between parental incarceration and child mortality risk. Methods. We used a sample of all Danish children born in 1991 linked with parental information. We conducted discrete-time survival analysis separately for boys (n = 30 146) and girls (n = 28 702) to estimate the association of paternal and maternal incarceration with child mortality, controlling for parental sociodemographic characteristics. We followed the children until age 20 years or death, whichever came first. Results. Results indicated a positive association between paternal and maternal imprisonment and male child mortality. Paternal imprisonment was associated with lower child mortality risks for girls. The relationship between maternal imprisonment and female child mortality changed directions depending on the model, suggesting no clear association. Conclusions. These results indicate that the incarceration of a parent may influence child mortality but that it is important to consider the gender of both the child and the incarcerated parent.

Background Despite a growing literature on the consequences of having a romantic partner incarcerated on women's risk of contracting sexually transmitted infections, little research considers the broader health profile of the female partners of ever-imprisoned men. Methods We use data from the Relate Project ( n = 332), a unique cross-sectional survey of recently released men and their female partners (2009–2011), to demonstrate that the female partners of recently released men suffer from a variety of health risks and conditions. We also examine the health conditions of females by their own incarceration history. Findings We find that these women engage in poor health behaviors including smoking, drug use, and excessive alcohol consumption and have high levels of health conditions including asthma, hypertension, anxiety, and depression. The vulnerability of women who had themselves been incarcerated in jails or prisons was especially acute. The number of risky background characteristics such as dropping out of high school (45%) and spending time in foster care or a group home (36%) were staggeringly high for ever-imprisoned women, as were their rates of anxiety (50%), depression (59%), and posttraumatic stress disorder (45%). Conclusions Results reveal that the health of the female partners of recently released men is at least as poor as that of their male partners, suggesting a degree of vulnerability that has yet to be considered in the medical or public health literature and a population that desperately needs medical attention with the full rollout of the Affordable Care Act in 2014.

In the United States, race and ethnicity are considered key social determinants of health because of their enduring association with social and economic opportunities and resources. An important policy and research concern is whether the U.S. is making progress toward reducing racial/ethnic inequalities in health. While race/ethnic disparities in infant and adult outcomes are well documented, less is known about patterns and trends by race/ethnicity among children. Our objective was to determine the patterns of and progress toward reducing racial/ethnic disparities in child health. Using nationally representative data from 1998 to 2009, we assessed 17 indicators of child health, including overall health status, disability, measures of specific illnesses, and indicators of the social and economic consequences of illnesses. We examined disparities across five race/ethnic groups (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic Asian, and non-Hispanic other). We found important racial/ethnic disparities across nearly all of the indicators of health we examined, adjusting for socioeconomic status, nativity, and access to health care. Importantly, we found little evidence that racial/ethnic disparities in child health have changed over time. In fact, for certain illnesses such as asthma, black–white disparities grew significantly larger over time. In general, black children had the highest reported prevalence across the health indicators and Asian children had the lowest reported prevalence. Hispanic children tended to be more similar to whites compared to the other race/ethnic groups, but there was considerable variability in their relative standing.

In 2010, the White House Task Force on Childhood Obesity provided benchmark goals for reducing childhood obesity. We evaluated the balance of prevention and treatment required for achieving Task Force goals in benchmark years 2015, 2020, and 2030. We created a simulation of US birth cohorts (2–19 years) born 2008–2030. For each year, we assumed “old” birth cohorts (part of previous benchmark obesity estimates) would benefit from obesity treatment strategies, and “new” birth cohorts would benefit from obesity prevention strategies. We assessed obesity prevalence that must be achieved through prevention strategies, under varying assumptions of treatment effectiveness. When we assumed a 1% absolute reduction in prevalence through treatment, we found that prevention strategies would need to achieve an obesity prevalence of 12% by 2015, 8% by 2020, and 0.3% by 2030. Because of higher obesity prevalence among minority children, prevention strategies would need to achieve a negative prevalence by 2030, which is implausible. Under more generous assumptions of treatment effectiveness, estimates became positive but remained low. Task Force goals are more difficult to achieve with each benchmark year. Policies must focus on obesity treatment interventions, particularly targeted to racial/ethnic minority children, to make progress in stemming the epidemic.

Mezuk et al. (1) tested and provided empirical support for the hypothesis that engaging in unhealthy behaviors modifies the impact of social stress on the risk of depression and that the relation between stress, behavioral coping, and depression operates differentially by race. This hypothesis was initially proposed and tested by Jackson et al. (2, 3) as a potential explanation for the ostensible epidemiologic paradox of lower rates of psychological distress among blacks compared with whites, despite greater exposure to social disadvantage and higher rates of physical morbidity. We recently conducted a third and more exhaustive empirical test of the hypothesis and failed to replicate these findings (4). Here, we highlight a number of theoretical and methodological concerns raised by Mezuk et al. (1). The proposition that coping behaviors might have different implications for physical illness and psychopathology (hereafter referred to as the Jackson hypothesis) is an interesting one that is worthy of investigation. However, as an explanation of the differences in the prevalence of depression in blacks and whites, the theory is problematic. For the Jackson hypothesis to plausibly explain the “paradox,” it must be true that 1) the physiologic impact of unhealthy behaviors on depression is differential by race and/or 2) unhealthy behaviors protect against depression in both blacks and whites, but blacks are more likely to engage in them, especially under conditions of stress. There is no established empirical or theoretical basis for the first supposition, and the authors do not explicate a mechanism by which the physiologic impact of health behaviors might differ by race. The second supposition is inconsistent with substantial empirical evidence of 1) comorbidity between substance disorders, obesity, and depression (5–7) and 2) levels of substance use and dependence among blacks that are lower than or comparable to those among whites (8–11). Of the behaviors being considered, only unhealthy eating is consistently more prevalent among blacks in the epidemiologic literature (12, 13). In our data, however, high body mass index was only protective against depression among blacks who reported no stressful life events (4), which is inconsistent with the theory's prediction of protective effects at high levels of stress. Mezuk et al. (1) also suggested that their findings may reflect in part the inadequacies of standard measures of social disadvantage in capturing the uniquely chronic and noxious stresses blacks experience. If the measures underestimate stress and disadvantage among blacks, however, the prevalence of both depression and poor health behaviors should be higher in blacks than in whites at a given level of stress. These patterns were not presented in the article by Mezuk et al. (1), and when examined in our analysis, they were not evident (4). Finally, Mezuk et al. (1) analyzed stressful life events as a continuous measure, assuming a linear relation between stress and depression among both blacks and whites. This assumption can and should be tested in their data; in our data, we observed that, among blacks, a count of stressful life events was not linearly related to depression. However, when modeled (incorrectly) as such, engaging in unhealthy behaviors did appear to be protective against depression at high levels of stress (4). Theories that generate specific testable hypotheses contribute enormously to the field of epidemiology. In addition, substantive explanations for the black/white paradox in depression are an important complement to the methodological interpretations that are more commonly advanced. Further theoretical and empirical attention to this issue is certainly warranted. However, a more promising theory would both posit specific etiologic mechanisms and account for established population-level empirical patterns. The Jackson hypothesis fails to attend fully to the latter and therefore cannot be regarded as a “comprehensive explanation” for the paradoxical racial patterning in physical and mental health outcomes (1, p. 1243).

Background Research suggests that reports of interpersonal discrimination result in poor mental health. Because personality characteristics may either confound or mediate the link between these reports and mental health, there is a need to disentangle its role in order to better understand the nature of discrimination-mental health association. We examined whether hostility, anger repression and expression, pessimism, optimism, and self-esteem served as confounders in the association between perceived interpersonal discrimination and CESD-based depressive symptoms in a race/ethnic heterogeneous probability-based sample of community-dwelling adults. Methods We employed a series of ordinary least squares regression analyses to examine the potential confounding effect of hostility, anger repression and expression, pessimism, optimism, and self-esteem between interpersonal discrimination and depressive symptoms. Results Hostility, anger repression, pessimism and self-esteem were significant as possible confounders of the relationship between interpersonal discrimination and depressive symptoms, together accounting for approximately 38% of the total association (beta: 0.1892, p

Background Healthcare discrimination based on race/ethnicity is associated with decreased healthcare access and utilization among racial/ethnic minority patients. Discrimination based on criminal record may also negatively impact healthcare access and utilization among ex-prisoners. Methods We conducted a secondary analysis of data from a cross-sectional survey of 172 men recently released from state prison. We examined the association between self-reported criminal record discrimination by healthcare workers and utilization of 1) emergency department (ED) and 2) primary care services. We created staged logistic regression models, adjusting for sociodemographic characteristics and self-reported racial/ethnic discrimination. Results Among 172 male participants, 42% reported a history of criminal record discrimination by healthcare workers. Participants who reported discrimination were older (mean, 42 vs. 39 years; p = .01), more likely to be college educated (26% vs. 11%; p = .03), and had more extensive incarceration histories (median years incarcerated, 16 vs. 9; p = .002) compared to those who did not report discrimination. Self-reported criminal record discrimination by healthcare workers was significantly associated with frequent ED utilization [odds ratio (OR) = 2.7, 95% confidence interval 24 (CI) 1.2-6.2] but not infrequent primary care utilization [OR = 1.6, 95% CI 0.7-3.8]. Conclusions Recently released prisoners report criminal record discrimination by healthcare workers, and this experience may impact healthcare utilization. Future studies should seek to further characterize criminal record discrimination by healthcare workers and prospectively examine its impact on health outcomes. Electronic supplementary material The online version of this article (doi:10.1186/2194-7899-2-6) contains supplementary material, which is available to authorized users.