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Background The unique challenges Black men face within the criminal justice system underscore structural and systemic factors driving widespread inequalities. The long-term effects of these challenges on economic, health, and social outcomes as individuals transition to retirement remain poorly understood, highlighting a critical gap in our knowledge of life trajectories long after justice system involvement. Objectives This study investigated the enduring health impacts of incarceration on Black men, particularly focusing on the transition into retirement. It aimed to explore the influence of race and gender on experiences of incarceration before age 50, and how such experiences affected self-rated health during the retirement transition. Methods Utilizing data from the Health and Retirement Study, which followed individuals aged 50–59 for up to thirty years, this research examined the interplay of race, gender, incarceration history, and self-rated health during the retirement transition. Logistic regression and path modeling were employed for data analysis. Results Logistic regression results indicated that being Black, male, and having lower educational attainment significantly increased the likelihood of experiencing incarceration before the age of 50 (p < 0.05). This suggests that Black men with lower levels of education are at the greatest risk of incarceration. The path model revealed a correlation between incarceration experiences before age 50 and poorer self-rated health at the time of retirement. Conclusion The findings highlighted the disproportionately high risk of incarceration among Black men, especially those with lower educational attainment, and its persistent negative impacts on health decades later, including during the transition into retirement. Addressing structural racism and the mass incarceration of Black men is crucial for achieving racial health equity as individuals retire.

BackgroundHigher education is widely recognized as a strategy to mitigate food insecurity. However, marginalized and racialized groups, especially Latinos, often do not experience the same economic and health benefits from their educational achievements as non-Latino Whites, highlighting a pattern of diminished returns within these communities.AimsThis study aims to explore the disparities in how educational attainment influences marital status and employment, and subsequently, food insecurity among Latino and non-Latino adults.MethodsUtilizing data from the 2022 National Health Interview Survey (NHIS), which encompassed 27,648 adults from both Latino and non-Latino backgrounds, this research applied a structural equation model to examine the relationship between educational attainment, ethnicity, and food insecurity. The study specifically focused on the mediating roles of marital status and employment.ResultsFindings reveal significant interactions between education and ethnicity affecting marital status and employment, both of which serve as protective factors against food insecurity. These results indicate that higher levels of unemployment and lower marriage rates may disproportionately escalate food insecurity among Latinos, irrespective of educational attainment.ConclusionThe study highlights profound societal and environmental obstacles that prevent Latinos from leveraging educational achievements to improve their marital and employment statuses, and thereby, their food security. Addressing these disparities demands targeted interventions directed at Latino communities to bridge gaps in employment and marriage rates stemming from educational disparities. A holistic strategy that transcends mere access to education is essential to dismantle the societal barriers that undermine the educational dividends for Latino communities.

Objectives: Educational attainment is a protective factor against poor health, but high educational attainment has a weaker effect on black people than on white people; this pattern has been called marginalization-related diminished returns (MDRs). Using a national sample of white people and black people 25 years and above, this study estimates the association between high educational attainment and allostatic load between black people and white people, and within each group. Study design: This cross-sectional study uses data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016, including 2761 black people and 7058 white people. The outcome variable of interest was the Allostatic Load Scale (AL). We created the allostatic load scale by using 8 biomarkers, then created a binary variable (if ALS≥4 as 1 and ALS

Objectives: Using a participatory research approach, this study reports the efficacy of the Communities Engaged and Advocating for a Smoke-free Environment (CEASE)-4 intervention offered by the local peers.Methods: CEASE-4 is a theory-based tobacco-cessation intervention, tailored to the needs of underserved populations. 842 tobacco users self-selected into: a) self-help (n = 472), b) single-session class (n = 163), and c) four-session class (n = 207). While self-help group only received educational materials, curriculum for other arms was built on the social cognitive, motivational interviewing, and trans-theoretical- frameworks. Participants could also receive nicotine replacement therapy (NRT). Outcome was self-reported smoking cessation measured 12 weeks after completion of the intervention, validated by exhaled carbon monoxide (CO) test.Results: Quit rate was statistically different across groups, with highest quit rate in four-session and lowest quit rate in self-help arm. Cessation rates at follow up (12 weeks after completion of the intervention) were 2.3% in the self-help arm, 6.1% in the single-session arm and 13.0% in the four-session arm.Conclusion: While theory-based smoking cessation services are effective for underserved populations, four-session curriculum might be superior to a single session program.

Background and aims: The nucleus accumbens (NAcc) functional and morphometric features may influence children’s body mass index (BMI). Recent evidence, however, suggests that the function and structure of the NAcc may have different predictive abilities for the BMI for the sub-groups of children from different racial and socioeconomic status (SES) backgrounds. Using the Adolescent Brain Cognitive Development data, this study investigated racial and SES differences in the association between NAcc microstructure (i.e., fractional anisotropy) and childhood BMI. Methods: This cross-sectional study included 9497 children aged 9 and 10. Data were collected from 21 sites across 15 states in the United States. Then, the mixed-effects regression model was applied for data analysis. The predictor variable of interest was NAcc fractional anisotropy measured using diffusion magnetic resonance imaging (dMRI). The main outcome of interest was children’s BMI values, which were treated as a continuous variable. Covariates included gender, age, and family structure. Race (White, Black, Asian, and Other/mixed) and family income ( < USD 50,000, USD 50,000-100,000, and USD100,000+) were the effect modifiers (moderators). Results: Higher average NAcc fractional anisotropy in dMRI was predictive of lower levels of the BMI, and net of covariates. However, this inverse association between the average intensity of the normalized T2-weighted image and the BMI was stronger in children from Hispanic, low income, and low-educated backgrounds compared to non-Hispanic, high-income, and high-educated backgrounds. Conclusion: Our findings suggested that although NAcc fractional anisotropy is linked to children’s BMI, this link is not invariant across racial and SES groups. The issue of whether or not obesogenic environments alter the implications of NAcc for childhood BMI needs further investigation. For diverse groups, NAcc microstructures may have different magnitudes of associations with childhood BMI.

IntroductionTobacco use disproportionately affects low-income African American communities. The recent public housing smoke-free policy has increased the demand for effective smoking cessation services and programs in such settings.MethodsThis mixed-method pilot study explored feasibility and potential impact of a peer-mentoring program for smoking cessation in a public housing unit. The quantitative study used a quasi-experimental design while qualitative data were collected via focus group discussions with peer mentors and participants. Three residents of the public housing complex were trained as peer mentors. Each peer mentor recruited up to 10 smokers in the residence and provided them individual support for 12 weeks. All participants were offered Nicotine Replacement Therapy (NRT). A follow-up investigation was conducted 3 months after completion of the 12-week intervention. At baseline and follow-up, the participants' smoking status was measured using self-report and was verified using exhaled carbon monoxide (eCO) monitoring.ResultsThe intervention group was composed of 30 current smokers who received the peer-mentoring intervention. The control group was composed of 14 individuals. Overall mean eCO levels dropped from 26 ppm (SD 19.0) at baseline to 12 (SD 6.0) at follow-up (P < 0.01). Participants who were enrolled in our program were more likely to have non-smoking eCO levels (

Educational attainment is among the most substantial protective factors against cigarette smoking, including during pregnancy. Although Minorities’ Diminished Returns (MDRs) of educational attainment, defined as weaker protective effect of education for racial and ethnic minority groups compared to Non-Hispanic Whites, has been demonstrated in previous studies; such MDRs are not tested for cigarette smoking during pregnancy. To better understand the relevance of MDRs to tobacco use during pregnancy, this study had three aims: firstly, to investigate the association between educational attainment and cigarette smoking in pregnant women; secondly, to compare racial and ethnic groups for the association between educational attainment and cigarette smoking; and thirdly, to explore the mediating effect of poverty status on such MDRs, among American adults during pregnancy. This cross-sectional study explored a nationally representative sample of pregnant American women (n = 338), which was taken from the Population Assessment of Tobacco and Health (PATH; 2013). Current smoking was the outcome. Educational attainment was the independent variable. Region and age were the covariates. Poverty status was the mediator. Race and ethnicity were the effect modifiers. Overall, a higher level of educational attainment (OR = 0.54, p < 0.05) was associated with lower odds of current smoking among pregnant women. Race (OR = 2.04, p < 0.05) and ethnicity (OR = 2.12, p < 0.05) both showed significant interactions with educational attainment on smoking, suggesting that the protective effect of educational attainment against smoking during pregnancy is smaller for Blacks and Hispanics than Non-Hispanic Whites. Poverty status fully mediated the above interactions. In the United States, highly educated pregnant Black and Hispanic women remain at higher risk of smoking cigarettes, possibly because they are more likely to live in poverty, compared to their White counterparts. The results suggest the role that labor market discrimination has in explaining lower returns of educational attainment in terms of less cigarette smoking by racial and ethnic minority pregnant women.

Background and aims: While increased parental education reduces children’s sleep problems, less is known about racial variation in such protection. According to Minorities’ Diminished Returns (MDRs) theory, economic resources such as parental education show weaker health effects for minority groups such as Blacks and Latinos than non-Latino Whites, which is due to racism and social stratification. In this study, we investigated the association between parental education and children’s sleep problems, as a proxy of sleep problems, by race. Methods: This cross-sectional study included 11718 American children aged 9-10. All participants were recruited to the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was parental education, a five-level nominal variable. The dependent variable – sleep problems, was a continuous variable. Race/ethnicity was the effect modifier. Age, sex, and marital status were the covariates. Mixed-effects regression models were used for data analysis. Results: Parental education was associated with children’s sleep problems. However, there was a weaker inverse association seen in non-Latino Black and Latino families compared to non-Latino White families. This was documented by a significant statistical interaction between race and ethnicity and parental education on children’s sleep problems. Conclusion: Diminished protective effect of parental education on children’s sleep problems for non- Latino Black and Latino families compared to non-Latino White families is similar to the MDRs in other domains. Worse than expected sleep may contribute to higher-than-expected health risks of middle-class Black and Latino children.

Introduction: Cerebellum cortex fractional anisotropy is a proxy of the integrity of the cerebellum cortex. However, less is known about how it is shaped by race and socioeconomic status (SES) indicators such as parental education and household income. Purpose: In a national sample of American pre-adolescents, this study had two aims: to test the effects of two SES indicators, namely parental education and household income, on cerebellum cortex fractional anisotropy, and to explore racial differences in these effects. Methods: Using data from the Adolescent Brain Cognitive Development (ABCD) study, we analyzed the diffusion Magnetic Resonance Imaging (dMRI) data of 9565, 9–10-year-old pre-adolescents. The main outcomes were cerebellum cortex fractional anisotropy separately calculated for right and left hemispheres using dMRI. The independent variables were parental education and household income; both treated as categorical variables. Age, sex, ethnicity, and family marital status were the covariates. Race was the moderator. To analyze the data, we used mixed-effects regression models without and with interaction terms. We controlled for propensity score and MRI device. Results: High parental education and household income were associated with lower right and left cerebellum cortex fractional anisotropy. In the pooled sample, we found significant interactions between race and parental education and household income, suggesting that the effects of parental education and household income on the right and left cerebellum cortex fractional anisotropy are all significantly larger for White than for Black pre-adolescents. Conclusions: The effects of SES indicators, namely parental education and household income, on pre-adolescents’ cerebellum cortex microstructure and integrity are weaker in Black than in White families. This finding is in line with the Marginalization-related Diminished Returns (MDRs), defined as weaker effects of SES indicators for Blacks and other racial and minority groups than for Whites.

Introduction: Although the putamen has a significant role in reward-seeking and motivated behaviors, including eating and food-seeking, minorities’ diminished returns (MDRs) suggest that individual-level risk and protective factors have weaker effects for Non-Hispanic Black than Non-Hispanic White individuals. However, limited research is available on the relevance of MDRs in terms of the role of putamen functional connectivity on body mass index (BMI). Purpose: Building on the MDRs framework and conceptualizing race and socioeconomic status (SES) indicators as social constructs, we explored racial and SES differences in the associations between putamen functional connectivity to the salience network and children’s BMI. Methods: For this cross-sectional study, we used functional magnetic resonance imaging (fMRI) data of 6473 9–10-year-old Non-Hispanic Black and Non-Hispanic White children from the Adolescent Brain Cognitive Development (ABCD) study. The primary independent variable was putamen functional connectivity to the salience network, measured by fMRI. The primary outcome was the children’s BMI. Age, sex, neighborhood income, and family structure were the covariates. Race, family structure, parental education, and household income were potential moderators. For data analysis, we used mixed-effect models in the overall sample and by race. Results: Higher right putamen functional connectivity to the salience network was associated with higher BMI in Non-Hispanic White children. The same association was missing for Non-Hispanic Black children. While there was no overall association in the pooled sample, a significant interaction was found, suggesting that the association between right putamen functional connectivity to the salience network and children’s BMI was modified by race. Compared to Non-Hispanic White children, Non-Hispanic Black children showed a weaker association between right putamen functional connectivity to the salience network and BMI. While parental education and household income did not moderate our association of interest, marital status altered the associations between putamen functional connectivity to the salience network and children’s BMI. These patterns were observed for right but not left putamen. Other/Mixed Race children also showed a pattern similar to Non-Hispanic Black children. Conclusions: The association between right putamen functional connectivity to the salience network and children’s BMI may depend on race and marital status but not parental education and household income. While right putamen functional connectivity to the salience network is associated with Non-Hispanic White children’s BMI, Non-Hispanic Black children’ BMI remains high regardless of their putamen functional connectivity to the salience network. This finding is in line with MDRs, which attributes diminished effects of individual-risk and protective factors for Non-Hispanic Black children to racism, stratification, and segregation.

Background and aims: Negative urgency reflects a specific facet of impulsivity and correlates with a wide range of health-related risk behaviors, including, but not limited to, problematic substance use. Negative urgency is also shaped by family socioeconomic position (SEP), such as parental educational attainment (PEA). This study aimed to explore sex differences regarding protective effects of PEA on children’s negative urgency in the US. Methods: This cross-sectional study used the Adolescent Brain Cognitive Development (ABCD) study data. Baseline ABCD data included 10,535 American children in the age range of 9-10 years old. The independent variable was PEA, treated as a 5-level categorical variable. The primary outcome was negative urgency measured by the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency, Impulsive Behavior Scale (UPPS-SS). Mixed-effects regression models were applied for data analysis. Results: In sex-stratified regression models, high PEA was predictive of lower levels of negative urgency in female but not male children. In the overall sample, sex showed a statistically significant interaction with PEA on children’s negative urgency, indicating a stronger protective effect of high PEA for female compared to male children. Conclusion: PEA was a more salient determinant of negative urgency in female children than male ones. Our results also showed that American boys tend to have high levels of negative urgency, which is a risk factor of drug use, at all parental education levels.

Introduction: Perceived discrimination is one of the reasons behind ethnic health disparities. However, less is known about racial and ethnic groups differ in social determinants of discrimination. This study was aimed to compare the association between household income and perceived discrimination among American children of different racial groups. Methods: The Adolescent Brain Cognitive Development (ABCD) study, a national longitudinal study, followed 4383 children 9-10 years old who were either European American, African American, Asian American, or mixed/other race for one year. We compared racial groups for the association between baseline household income and perceived discrimination at the end of one year follow up. We used ANOVA and linear regression for data analysis. The outcome was perceived discrimination. The predictor was household income. Covariates were age, gender, and parental marital status. The moderator was race. Results: In the total sample, high household income was associated with less perceived discrimination. There was an interaction between race and household income, suggesting a difference in the association between household income and perceived discrimination between African American and European American children. The inverse association between household income and perceived discrimination was weaker for African American than European American children. Conclusion: High-income African American children are not well protected against perceived discrimination. High exposure to perceived discrimination may explain the worse expected health and development of middle-class African American children. As discrimination is a major social determinant of health, the results have considerble implications for public health policy.

Introduction: Relative to socially privileged groups, socially marginalized people experience weaker health effects of household income and other economic resources, a pattern known as Minorities’ Diminished Returns (MDRs). These MDRs are frequently seen in racial and ethnic minorities, but less is known about the relevance of such MDRs in immigrant families. To investigate the MDRs of household income on children’s depression as a function of immigration, we compared non-immigrant and immigrant children for the effect of household income on children’s depressive symptoms. Methods: This cross-sectional study was conducted across multiple cities in the United States. Baseline data from the Adolescent Brain Cognitive Development (ABCD) study collected in 2018 was used. A total of 6,412 children between the ages of 9-10 years old were included. The predictor variable was household income. The primary outcome was children’s depression measured by the Child Behavior Checklist (CBCL). Race, ethnicity, age, sex, parental marital status, parental employment, and financial difficulties were the covariates. Immigration status was the effect modifier. Results: Overall, high household income was associated with lower children’s depressive symptoms. Immigration status showed a statistically significant interaction with household income on children’s depression. This interaction term suggested that high household income has a smaller protective effect against depression for immigrant children than non-immigrant children. Conclusion: The protective effect of household income against children’s depression is diminished for immigrant than non-immigrant children.

Background: As shown by Minorities’ Diminished Returns (MDRs), ethnic minorities show weaker than expected effects of education level on health outcomes. However, this pattern is better demonstrated for health behaviors and health care utilization than satisfaction with care. Additionally, more is known about MDRs in African Americans than the Latino population. Thus, there is a need to study MDRs of education on healthcare satisfaction in highly educated African American and Latino individuals. Objectives: We tested ethnic differences in the association between education level and satisfaction with healthcare among American adults. Methods: The National Health Interview Survey (2015) included 24,835 adults who were Latino, non-Latino, African American, or White. The independent variable was education level. The dependent variable was satisfaction with healthcare. Age, gender, marital status, employment, region, physical health (self-rated health, and chronic diseases, body mass index), and mental health (psychological distress) were the covariates. Ethnicity was the moderator. Logistic regression was used for data analysis. Results: Higher education level was associated with higher satisfaction with healthcare in White but not African Americans. In the pooled sample, African American ethnicity showed a significant statistical interaction with education level suggesting a significantly smaller effect of high educational attainment on satisfaction with healthcare for African Americans than White adults. A similar interaction could not be found for Latino ethnicity, suggesting that education similarly enhances healthcare satisfaction for Latino and non-Latino adults. Conclusion: High education level boosts satisfaction with healthcare for Whites but not African Americans.

Background: Household income and other socioeconomic position (SEP) indicators are among the most salient social determinants of children’s emotions and behaviors. Some research has shown that income and other SEP indicators may have certain sex-specific effects on the structures and functions of particular brain regions. Objectives: To investigate sex differences in the association of household income with amygdala volumes in US children. Materials & Methods: This is a cross-sectional study using data from the Adolescent Brain Cognitive Development (ABCD) study. The study data was collected between 2016 and 2018 across 21 sites distributed across US states. Wave 1 ABCD included 10262 American children aged between 9 and 10 years old. The independent variable was household income. The primary outcome was the left amygdala volume, which was measured by T1-weighted structural brain Magnetic Resonance Imaging (MRI). We used a data exploration and analysis portal for our data analysis. Results: Overall, the household income was positively associated with left amygdala size in children. Sex showed a statistically significant interaction with household income on children’s left amygdala volume, net of all confounders, indicating a stronger effect of high household income on male children compared to female children. Conclusion: Household income is a more salient determinant of left amygdala volume for male children compared to female American children. Low-income male children remain at the highest risk of a small amygdala.

Background: Based on the Marginalization-related Diminished Returns (MDRs) framework, high socioeconomic status (SES) such as parental education shows weaker effects for Blacks than Whites. For example, high SES Black individuals report a high level of depression, anxiety, suicide, chronic disease, smoking, and mortality. Limited knowledge exists on MDRs of parental education on dietary behavior. Aims: Built on the MDRs framework, we tested the hypothesis of whether the effect of parental education on eating breakfast differs for Black compared to White families. We hypothesized that there is an association between mothers’ educational attainment and eating breakfast and compared Blacks and Whites for the effect of mothers’ educational attainment on the frequency of eating breakfast. Methods: The Fragile Families and Child Wellbeing Study is a 15-year follow up study of a random sample of births in cities larger than 200,000 population. The predictor was parental education at birth. The outcome was the frequency of eating breakfast at age 15. Linear regression was used for data analysis. Results: Maternal educational attainment at birth was positively associated with youth frequency of eating breakfast among Whites, not Blacks. We also found a significant interaction between maternal educational attainment at birth and race, suggesting that the association between maternal education and youth frequency of eating breakfast at age 15 was weaker for Black than White families. Conclusions: Diminished returns of maternal educational attainment on healthy youth diet may contribute to the racial disparities in poor health of high SES Black families. That is, a smaller protective effect of maternal education on changing health behaviors for Black than White youth may be one of the mechanisms by which health is worse than expected in high SES Black families. The health disparities are not only due to racial differences in SES but also the diminishing returns of socioeconomic status indicators such as education for racial minorities. Research should study contextual and structural factors that reduce Black families’ ability to mobilize their human capital and secure health outcomes in urban settings.

Currently, metabolic syndrome has become a global health problem. Alterations in neurocognitive functions among patients with metabolic syndrome are important issues in this disorder. In this paper, studies on metabolic syndrome were reviewed and their importance emphasized for the benefit of experts and policy makers. Metabolic syndrome activates inflammatory mediators that disrupt brain metabolism. These mediators can be activated by metabolic inflammation and microvascular disorders and may further cause damage to the white matter and impair cognitive function. These alterations can result in serious changes in cognitive abilities. The association between cognitive changes and metabolic syndrome has been independently evaluated in several studies. In addition, some areas of research in the field of metabolic syndrome include the effectiveness of neurocognitive interventions to enhance normal behaviors or reduce risky behaviors in patients. Structural brain correlates of health-related behaviors provide a basis for designing more effective behavioral interventions by identifying the corresponding brain regions and using behavioral interventions.

Introduction: Although education is among the major socioeconomic status (SES) resources that influence populations’ and individuals’ health, social marginalization may reduce the health gain that follows access to SES indicators such as education, a pattern called marginalization-related diminished return (MDR). The literature on MDRs, however, has been mainly derived from studies that have defined marginalization based on race, ethnicity, and sexual orientation. Thus, more research is needed on MDRs that may follow as a result of immigration. To extend what is known on immigration status related MDRs, this study compared a national sample of immigrants and non-immigrants for the effect of education on the poor self-rated health (SRH) of adults in the United States. Methods: With a cross-sectional design, this study employed data from the 2015 National Health Interview Survey (NHIS), a survey that had enrolled 33,654 adults who were either immigrants (n = 6225; 18.5%) or non-immigrants (n = 27 429; 81.5%). The independent variable was education level, treated as a categorical variable. The dependent variable was poor SRH treated as a dichotomous variable. Race, ethnicity, age, gender, marital status, and region were the confounders. Immigration (nativity) was the moderator. Logistic regression was used for data analysis. Results: Higher education credentials were associated with better SRH in the pooled sample; however, immigration showed a significant statistical interaction with education level (college graduation) on the outcome. This interaction was indicative of a smaller protective effect of college graduation on poor SRH among immigrants than non-immigrant adults. Conclusion: In line with the MDRs framework, the effect of education on SRH is weaker for immigrants than for non-immigrant adults. There is a need to help highly educated immigrants to mobilize their human capital to secure their best health outcomes, similar to non-immigrants. Such strategies may require bold and innovative policy solutions to reduce discrimination against immigrants, so they can more effectively translate their education and human capital into tangible outcomes such as health.

Most of what we know about the coronavirus disease 2019 (COVID-19) is limited to the severe acute respiratory syndrome, epidemiology, fatality, and acute care. However, infection with COVID-19 may also involve the central nervous system (CNS), which may or may not be due to a multi-organ injury. Our aim in this paper is to briefly summarize the main aspects of the growing literature on neurological manifestations of the COVID-19 infection. As such, after mentioned some general background on the economic and medical pandemic on the populations, the healthcare system, and the society, we summarize some common aspects of the published literature on neurological manifestations of the COVID-19 infection. We also highlight the existing gaps in the literature, which requires additional work. The most common neurological manifestation of COVID-19 infection is the olfactory deficit. However, it is still unknown if it is inflammatory or degenerative in nature. Still, the incidence of neurological involvement, and also mechanisms and their treatments are unknown. This literature is predominantly composed of opinions and reviews rather than original articles, so the patients’ data are not used for a majority of the studies. Multi-center studies that not only conduct chest CT or MRI but also brain CT or MRI are needed. Randomized trials are still required on the management of acute and chronic neurological conditions due to COVID-19 infection. Cohort studies may also determine the natural history of the conditions and factors that are prognostic. Furthermore, while disparities in COVID-19 infections are known, inequalities in neurological manifestations are unknown. Besides, the efficacy of specific treatments on CNS involvement is still unknown. We will discuss the health care needs of patients with chronic neurological conditions. We end the paper with a few recommendations for practice and research.

The experience of the loss of the relatives, which is naturally one of the most stressful events in a person’s life, has turned into a new concept and challenge for survivors and mental health professionals during the coronavirus era. We discussed how restrictions caused by social distancing potentially increase the likelihood of a phenomenon called complicated grief or prolonged bereavement disorder and multilayer response by case finding to increase the access to public education to manage this complicated situation.

Background: A wide array of Socioeconomic Status (SES) indicators show differential effects for the members of diverse social groups. Researchers know a little about the ethnic variation and the effects of family income on delay discounting which is the predictor of risk behaviors. Objectives: This study examined the effect of family income and its differences on delayed gratification between Latino and non-Latino children. Materials & Methods: In this cross-sectional analytical study, data came from wave one of the Adolescent Brain Cognitive Development (ABCD) study which included 3903 non-Latino or Latino Black or White American children who are between 9 and 10 years old. The predictor was family income. Data were collected from 21 sites in the US, in 2018. The outcome was the children’s delay discounting. We measured delay discounting, which reflected individuals’ tendency to assign less value to remote outcomes and rewards (inversely correlated with delayed gratification). Data analysis was done by linear regression in SPSS V. 22. Results: According to our pooled sample regression, higher family income was associated with lower children delay discounting (Beta=-0.05, P=0.021). We found a significant interaction between family income and ethnicity, suggesting that the association between family income and delay discounting is stronger for Latino compared with non-Latino children (Beta=-0.09, P=0.043). Conclusion: Not all ethnic disparities are due to socioeconomic status gaps. Across diverse social groups, differential returns of socioeconomic status indicators, such as family income, also contribute to ethnic disparities in health.

Background and aims: Although actual and perceived obesity are associated, some research has shown that this association may differ across racial and ethnic groups. Accordingly, this cross-sectional study tested racial differences regarding the association between actual and perceived obesity among American adults. Methods: The Health Information National Trends Survey (HINTS 5- Cycle 3) is a representative survey of American adults conducted in 2019. A total number of 3731 adults entered our analysis, including 3054 (81.9%) non-Hispanic Whites and 677 (18.1%) African-Americans (AAs). The independent variable was actual obesity, which was defined as a body mass index of equal or more than 30. The outcome was perceived as obesity. In addition, age, gender, marital status, education, and income were considered as control variables (confounders), and the race was the focal effect modifier. Finally, logistic regressions without and with interaction terms were utilized to analyze the data. Results: Overall, actual and perceived obesity were associated with individuals with obesity having higher odds of finding self as obese (odds ratio [OR]=25.82, 95% CI=18.58-35.89, P

Background and aims: This study aimed to compare non-Hispanic Black (NHB) and non-Hispanic White (NHW) American adults for the associations of educational attainment and household income with perceived racial discrimination. Methods: The 2010 National Alcohol Survey (NAS N12), a nationally representative study, included 2635 adults who were either NHB (n=273) or NHW (n=2362). We compared NHBs and NHWs for the associations between education, income, and perceived racial discrimination. We used linear regression for data analysis. Outcome was perceived racial discrimination; the predictors were educational attainment and household income; covariates were age and gender; and moderator was race. Results: In the total sample, high income was associated with lower levels of perceived racial discrimination, while educational attainment was not significantly associated with perceived racial discrimination. There was also an interaction between race and education but not household income, suggesting a difference in the association between educational attainment and perceived racial discrimination between NHB and NHW individuals. For NHW individuals, household income was inversely associated with perceived racial discrimination. For NHB individuals, however, household income was not related to perceived racial discrimination. For NHB but not NHW individuals, educational attainment was correlated with more not less perceived racial discrimination. Conclusion: High income protects NHW but not NHB individuals against perceived racial discrimination, and NHB individuals with high education levels report more not less perceived racial discrimination.

To investigate racial and ethnic differences in the protective effects of parental education and marital status against adolescents’ depressed mood and suicidal attempts in the U.S. As proposed by the Marginalization-related Diminished Returns (MDRs), parental education generates fewer tangible outcomes for non-White compared to White families. Our existing knowledge is very limited regarding diminished returns of parental education and marital status on adolescents’ depressed mood and suicidal attempts. To compare racial groups for the effects of parental education and marital status on adolescents’ depressed mood and suicidal attempt. This cross-sectional study included 7076 non-Hispanic White or African American 8-11 years old adolescents from the Adolescent Brain Cognitive Development (ABCD) study. The independent variables were parental education and marital status. The main outcomes were depressed mood and suicidal attempts based on parents’ reports using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Age and gender were the covariates. Race was the moderator. Logistic regression was used to analyze the ABCD data. Overall, parental education was associated with lower odds of depressed mood (OR = 0.81; 95% CI = 0.67–0.99; p = 0.037) and having married parents was associated with lower odds of suicidal attempts (OR = 0.50; 95% CI = 0.28–0.91; p = 0.022). In the pooled sample, we found interaction terms between race with parental education and marital status on the outcomes, suggesting that the protective effect of having married parents against depressed mood (OR = 1.54; 95% CI = 1.00–2.37; p = 0.048) and the protective effect of having married parents against suicidal attempts (OR = 6.62; 95% CI = 2.21–19.86; p = 0.001) are weaker for African Americans when compared to Whites. The protective effects of parent education and marital status against depressed mood and suicidal attempts are diminished for African American adolescents compared to White adolescents. There is a need for programs and interventions that equalize not only socioeconomic status (SES) but also the marginal returns of SES for racial minority groups. Such efforts require addressing structural and societal barriers that hinder African American families from translating their SES resources and human capital into tangible outcomes. There is a need for studies that can minimize MDRs for African American families, so that every individual and every family can benefit from their resources regardless of their skin color. To achieve such a goal, we need to help middle-class African American families secure tangible outcomes in the presence of SES resources.

Background: Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. The role of MDRs as a source of ethnic health disparities is, however, still unknown. Objectives: The current study had two aims: first, to explore the association between years of schooling and having taken a prostate-specific antigen (PSA) test among men in the US, and second, to explore ethnic differences in this association. Methods: This study was a secondary analysis of data from the National Health Interview Survey (NHIS-2015). The data of 5,053 men aged 55 years or older who were either Latino, non-Latino, African–American, or White were analyzed. Years of schooling was the independent variable. The dependent variable was taking a PSA test sometime during one’s lifetime. Age, region, and employment were the control variables. Ethnicity was the focal moderating variable. Binary logistic regression was used for data analysis. Results: A higher number of years of schooling was associated with higher odds of having taken a PSA test, net of all confounders. Ethnicity showed a significant statistical interaction with years of schooling on having taken a PSA test. This interaction was suggestive of a smaller slope for Latino men than non-Latino men. White and African American men did not show differential effects of years of schooling on having taken a PSA test. Conclusion: Similar to the MDRs patterns in other domains, non-Latino White men show more health gain from their years of schooling than Latino men. Highly educated Latino men still need programs to encourage their use of prostate cancer screening.

Introduction: Although socioeconomic status (SES) resources influence population and individual health behaviors, socially marginalized groups gain significantly less health from their SES indicators, such as education and income, compared to the socially privileged groups. This pattern is called marginalization-related diminished returns (MDRs). However, most of the MDRs literature is derived from studies that have defined marginalization based on race and ethnicity. As a result, more research is needed on MDRs due to immigration. To extend what is known about MDRs due to immigration, the current study compared a national sample of immigrants and non-immigrants for the effects of education and income on current cigarette smoking of adults in the United States. Methods: This is a cross-sectional study. The 2015 National Health Interview Survey (NHIS) enrolled 14,149 individuals who were either immigrants (n=1977; 14.0%) or non-immigrants (n=12,166; 86.0%). The independent variables (IV) were education and income that were treated as categorical variables. The dependent variable was current cigarette smoking. Age, gender, race, ethnicity, marital status, employment, and region were confounders. Immigration was the moderator. Logistic regression was used for data analysis. Results: High education and income were associated with lower odds of current cigarette smoking. However, immigration showed significant statistical interactions with both education and income. These interactions were suggestive of smaller protective effects of high education and income on current cigarette smoking for immigrant than non-immigrant adults. Conclusion: In line with the MDRs, the effects of education and income on tobacco use is weaker for immigrant than non-immigrant adults.

Background: The literature on Minorities’ Diminished Returns (MDRs) have shown worse than expected health of the members of racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational attainment on preventive care and disease management in highly educated racial and ethnic minorities. Objectives: The current study explored the racial and ethnic differences in the effect of baseline educational attainment on % adherance to the routine physician visits among middle-aged and older adults in the US. Methods: This is a prospective study with 24 years of follow up. The Health and Retirement Study (HRS: 1992-2016) included 10 880 middle-aged and older adults who were Hispanic, non-Hispanic, Black or White. The independent variable was educational attainment. The dependent variable was adherance to the routine physician visits (%). Age, gender, marital status, income, health behaviors (smoking and drinking) and health (depression, self-rated health, and chronic diseases) were the covariates. Race and ethnicity were the focal moderators. Linear regression was used for data analysis. Results: Overall, higher educational attainment was associated with higher % of adherance to the routine physician visits over the course of follow-up, net of all confounders. Race showed a significant statistical interaction with educational attainment suggesting of a smaller effect of high education attainment on % adherance to the routine physician visits for Black than White middle-aged and older adults. Similar interaction could not be found for the comparison of Hispanic and non-Hispanic middle-aged and older adults. Conclusion: Educational attainment is associated with a larger increase in preventive and disease management doctor visits for White than Black middle-aged and older adults. This is a missed opportunity to improve the health of highly educated middle-aged and older adults. It is not race/ethnicity or class that shapes health behaviors but race/ethnicity and class that shape people’s pro-health behaviors. At least some of the racial health disparities is not due to low SES but diminished returns of SES.

Introduction: Although income is among the major social determinants of mental health of middle-aged and older individuals, socially marginalized groups gain less health from their income and other socioeconomic status (SES) resources compared to socially privileged groups. This pattern is called marginalization-related diminished returns (MDRs). Most of the existing knowledge on MDRs, however, has been derived from studies that have defined marginalization based on race, ethnicity, or sexual orientation. As a result, very limited information exists on whether similar MDRs can be observed for middle-aged and older immigrants or not. Building on the MDRs framework, this study compared a national sample of immigrants and non-immigrants for the effects of income on the mental well-being of middle-aged and older adults in the United States. Methods: This is a cross-sectional study. The 2015 National Health Interview Survey (NHIS) enrolled 14 149 middle-aged and older individuals who were either immigrants (n=1977; 14.0%) or non-immigrants (n=12 166; 86.0%). The independent variable (IV) was income that was treated as a continuous variable. The dependent variable was mental well-being, also treated as a continuous variable. Age, gender, race, ethnicity, education, marital status, employment, self-rated health, obesity, and region were confounders. Immigration (nativity status) was the moderator. Logistic regression was applied for data analysis. Results: High income was associated with higher odds of good mental well-being in middle-aged and older adults. However, immigration showed a significant statistical interaction with income, which was suggestive of a smaller protective effect of high income on mental well-being for immigrant than non-immigrant middle-aged and older adults. Conclusion: In line with MDRs, the association between income and mental well-being is weaker for immigrant than non-immigrant middle-aged and older adults. There is a need to help high income immigrants secure health outcomes similar to those of non-immigrants. Such changes may require bold and innovative economic, public, and social policies that help immigrants more effectively translate their income and socioeconomic resources into tangible outcomes such as mental well-being.

Background and aims: Minorities’ Diminished Returns (MDRs) refer to the smaller effects of educational attainment for ethnic minorities compared to the majority group. As a result of MDRs, research has documented more than expected tobacco use among Hispanics and African Americans (AAs) with high educational attainment. In theory, some of this increased risk may be due to lower tobacco harm knowledge. Accordingly, the present study compared ethnic groups for the association between educational attainment and tobacco harm knowledge among American adults in order to better understand a potential mechanism behind MDRs of educational attainment on tobacco use of Hispanics and AAs. Methods: The current cross-sectional study used baseline data of 27,405 adults, which were obtained from the Population Assessment of Tobacco and Health (2013) study a nationally representative survey in the United States. The independent and dependent variables were educational attainment and tobacco harm knowledge, respectively. In addition, age, gender, employment, and poverty status were the covariates and ethnicity was the moderator. Finally, linear regression was used to analyze the data. Results: Educational attainment was inversely associated with tobacco harm knowledge in the pooled sample (b=0.11, 95% CI=0.09 - 0.13). Ethnicity showed a statistically significant interaction with educational attainment (b=-0.05, 95% CI=-0.10 - 0.00 for AAs and b=-0.14, 95% CI=-0.19 - -0.09 for Hispanics versus non-Hispanics), suggesting that the effect of educational attainment on tobacco harm knowledge was smaller for Hispanics and AAs compared to non-Hispanics and Whites. Conclusion: In general, although high educational attainment increases tobacco harm knowledge, highly educated Hispanics and AAs still report a disproportionately low level of tobacco harm knowledge. Eventually, the MDRs of educational attainment on tobacco harm knowledge may explain why highly educated Hispanics remain at high risk of tobacco use.

Background and aims: According to the sponge hypothesis, compared to men’s self-rated health (SRH), women’s SRH is more likely to reflect conditions other than chronic medical conditions (CMCs) such as psychiatric disorders (PDs). As a result, poor SRH is a weaker predictive factor for mortality risk for women than men. Most of this literature, however, is done in samples that are predominantly middleclass White. To test the sponge hypothesis among economically disadvantaged African Americans (AAs), this study compared low-income AA men and women for the effects of the number of PDs and CMCs on SRH. Materials and Methods: This cross-sectional study recruited a non-random sample (n=150) of economically disadvantaged AA adults with PD(s). Structured face-to-face interviews were used to collect data. SRH was measured using a single-item measure. PDs and CMCs were also self-reported. We applied linear regression models to test the interactions between SRH and the number of PDs and CMC as well as gender. Results: The number of PDs and CMCs were associated with SRH in the pooled sample of low-income AA adults with PD(s). However, we found a significant interaction between the number of PDs and gender. This interaction suggested a stronger association between PDs and SRH for AA women than AA men. Gender did not alter the association between the number of CMCs and SRH. Conclusion: The number of PDs is a determinant of SRH for low-income AA women but not AA men, supporting the sponge hypothesis.

Background: The Minorities’ Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites. Objective: The current study explored the racial and ethnic differences in the association between educational attainment and Breast Physical Exam (BPE) among women in the U.S. Methods: The National Health Interview Survey (NHIS 2015) included 12 510 women who were Hispanic or non-Hispanic Black or White people. The independent variable was the level of educational attainment. The dependent variable was lifetime BPE. Age, region, marital status, and employment were the covariates. Race and ethnicity were the focal moderators. Logistic regressions were used for data analysis. Results: Overall, higher educational attainment was associated with higher odds of BPE, net of all confounders (odds ratio [OR]=1.11, 95% CI=1.09-1.13). Ethnicity showed a significant statistical interaction with educational attainment on BPE (OR=0.96, 95% CI=0.93-1.00), which was suggestive of a smaller effect of high education attainment on BPE for Hispanic than non-Hispanic women. The same interaction could not be found for the comparison of White and Black women (OR = 0.98, 95% CI =0.94-1.02). Conclusion: In line with other domains, non-Hispanic White women show a larger amount of health gain from their educational attainment than Hispanic women. It is not ethnicity or class but ethnicity and class that shapes how people engage in pro-health behaviors. This result may help hospitals and healthcare systems to better reduce health disparities in their target populations.

Introduction: Educational attainment and poverty status are two strong socioeconomic status (SES) indicators that protect individuals against exposure to second-hand smoke. Minorities’ Diminished Returns (MDRs), however, refer to smaller protective effects of SES indicators among ethnic minority groups such as Hispanics and Blacks, compared to non-Hispanic Whites. This study explored ethnic differences in the effects of educational attainment and poverty status on second-hand smoke exposure in the homes of American adults. Methods: This cross-sectional study included 18,274 non-smoking adults who had participated in the Population Assessment of Tobacco and Health (PATH; 2013). The independent variables were educational attainment and poverty status. The dependent variable was second-hand smoke exposure at home. Age and region of residence were the covariates. Ethnicity was the moderator. Results: Overall, individuals with a higher educational attainment (odds ratio [OR] = 0.76, 95% CI = 0.74-0.79) and those who lived out of poverty (OR = 0.56, 95% CI =0.51-0.62) had lower odds of second-hand smoke exposure at home. Hispanic ethnicity showed significant interactions with both SES indicators, suggesting that the protective effects of education and poverty on second-hand smoke exposure at home are smaller for Hispanics (ORs for interaction with education and poverty status = 1.30 and 1.26, P < 0.05) than for Non-Hispanics. Conclusion: In the US, high SES Hispanics remain at high risk of exposure to second-hand smoke at home despite a high education and income. High SES better reduces environmental exposures for non-Hispanic than for Hispanic individuals.

Background: Previous research has documented bidirectional associations between age at childbirth and socioeconomic status (SES) among mothers. Built on the Marginalization-related Diminished Returns (MDRs) theory, this study compares the association between maternal age at childbirth and income between non-Hispanic Blacks and non-Hispanic Whites. Methods: We used the data of the Fragile Families and Child Well-being Study (FFCWS), a longitudinal study from 1998 to 2016 in the United States (US). This study included 2922 women who were non-Hispanic White (n=776) or non-Hispanic Black (n=2146). Maternal age at childbirth was the independent variable, and income was the dependent variable. Educational attainment, marital status, delivery characteristics, car ownership, and welfare dependence were the covariates. For data analysis, linear regressions were applied. Results: Higher maternal age at childbirth was associated with higher income (adjusted b=0.30). We found a significant interaction between maternal age at childbirth and race on income, suggesting that the positive association between mothers’ age at childbirth and income was weaker for non-Hispanic Blacks than non-Hispanic Whites (b=-1.14, 95% CI=-1.50, -0.77). Conclusion: Postponing childbirth may have a smaller economic return for non-Hispanic Black women, which is in line with Marginalization-related Diminished Returns theory. Diminished returns of postponing reproduction may be a result of social stratification and structural inequalities that separate the lived experience of Blacks and Whites in the United States.

Introduction: Although educational attainment is protective against health risk behaviors such as smoking, the Minorities’ Diminished Return theory posits that these protective effects are smaller for ethnic minorities than majority groups. This study compared the effects of educational attainment on the smoking status of American Indian/Alaska Native (AIAN) and White adults. Methods: Data came from the National Health Interview Survey (NHIS - 2015). A total number of 21 114 individuals entered the current analysis. The independent variable was years of schooling. The dependent variable was current smoking status. Age, gender, region, marital status, and employment were covariates. Ethnicity was the moderator. Results: Overall, educational attainment was inversely associated with current smoking. Ethnicity showed a significant interaction with educational attainment that suggested that the protective effects of educational attainment against smoking are smaller for AIAN than for Whites. Conclusion: In the United States, while educational attainment helps individuals stay healthy by avoiding high risk behaviors such as smoking, this effect is smaller for AIANs than Whites, resulting in additional risk of smoking in highly educated AIANs. To reduce ethnic disparities in tobacco use, it is important to go beyond SES inequalities and investigate why high SES ethnic minorities remain at high risk of tobacco use.

Background: As suggested by the Minorities’ Diminished Returns (MDRs) theory, educational attainment shows a weaker protective effect for racial and ethnic minority groups compared to non-Hispanic Whites. This pattern, however, is never shown for hospitalization risk. Objectives: This cross-sectional study explored racial and ethnic variations in the association between educational attainment and hospitalization in the United States. Methods: Data came from the National Health Interview Survey (NHIS 2015). The total sample was 28,959 American adults. Independent variables was educational attainment. The main outcome was hospitalization during the last 12 months. Age, gender, employment, marital status, region, obesity, and number of cardiovascular conditions were covariates. Race and ethnicity were the effect modifiers. Logistic regression models were utilized to analyze the data. Results: From all participants, 16.2% were Black and 11.6% were Hispanic with a mean age of 51 years. Overall, higher education levels were associated with lower odds of hospitalization, independent of all confounders. Educational attainment showed significant interactions with race (odds ratio [OR] =1.04, 95% CI = 1.01-1.08) and ethnicity (OR = 1.04, 95% CI =1.01-1.07) on hospitalization, indicating smaller protective effects of educational attainment on hospitalization of Hispanics and Blacks than non-Hispanic Whites. Conclusion: The protective effects of educational attainment on population health are smaller for Blacks and Hispanics compared to non-Hispanic Whites. To prevent health disparities, the diminished returns of educational attainment should be minimized for racial and ethnic minorities. To do so, there is a need for innovative and bold economic, public, and social policies that do not limit themselves to equalizing socioeconomic status, but also help minorities leverage their available resources and gain tangible outcomes.

Introduction: Socioeconomic status (SES) indicators are among the main social determinants of health and illness. Less, however, is known about the role of SES in the epidemiology of polypharmacy in immigrant Latino Americans living in the United States. This research studied the association between three SES indicators, education, income, and employment, and polypharmacy in older first generation Latino American immigrant adults. Methods: Data was obtained from the Sacramento Area Latino Study on Aging (SALSA, 1996-2008). A total of 632 older first generation Mexican-American immigrants to the U.S. entered this analysis. The independent variables were education, income, and employment. Polypharmacy was the outcome. Age, gender, physical health, smoking, and drinking were the covariates. Binary logistic regression was used to analyze the data. Results: Employment was associated with lower odds of polypharmacy. The association between education and polypharmacy was above and beyond demographic factors, physical health, health behaviors, and health insurance. Neither education nor income were associated with polypharmacy. Other determinants of polypharmacy were poor self-rated health (SRH) and a higher number of chronic medical conditions (CMCs). Conclusion: Employment appears to be the major SES determinant of polypharmacy in older foreign-born Mexican Americans. Unemployed older Mexican American immigrants with multiple chronic diseases and those who have poor SRH have the highest need for an evaluation of polypharmacy. Given the age group of this population, most of them have health insurance, which provides an opportunity for reducing their polypharmacy.

Background: Minorities’ diminished returns (MDRs) refer to smaller protects health effects of socioeconomic status (SES) indicators for Blacks and other minority groups than Whites. Objectives: The current study aimed to explore Black - White differences in the association between educational attainment and exercise frequency among women in the US. Methods: For the current study,weused the National Survey of American Life’s (NSAL) data, which included 3175womenwhowere either White (n = 876) or Black (n = 2299). The independent variable was educational attainment. The dependent variable was exercise frequency. Age, region, household income, financial distress, marital status, unemployment, and depression were the covariates. Race was the focal moderator. Linear regression was applied for data analysis. Results: In the overall sample of women, high educational attainment was associated with higher exercise frequency (b = 0.07, 95% CI = 0.02 - 0.12). Race and educational attainment showed a significant interaction (b = -0.09, 95% CI = -0.19 - 0.00), suggestive of a smaller effect of education attainment on exercise frequency for Black women than White women. In race specific models, high educational attainment was associated with higher exercise frequency for White (b = 0.12, 95% CI = 0.04 - 0.20) but not Black (b = 0.03, 95% CI = -0.03-0.08) women. Conclusions: In line with the past research on MDRs, Whitewomengain more health from their educational attainment than Black women. It is not race or class but race and class that shape the health behaviors of American women.

Background and aims: As suggested by the Minorities’ Diminished Return Theory, the association between socioeconomic status and health is weaker for racial and ethnic minorities compared to Whites. The current study compared Blacks and Whites in terms of the association between marital status and physical health. Methods: The State of the State Survey (SOSS) included 881 adults (92 Blacks and 782 Whites) generalizable to the state of Michigan, the United States. The marital status and self-rated physical health (SRPH), which was measured using a single item, were considered as independent and dependent variables, respectively. In addition, age, gender, education, and employment were covariates and race/ ethnicity was regarded as the moderating factor. Finally, logistic regression was used for data analysis. Results: Based on the results, being married was associated with better SRPH, which is the net considered by all confounders. A significant interaction was found between race and marital status on SRPH, suggesting a larger association for Blacks compared to Whites. In race stratified models, marital status was related to better SRPH for Whites and Blacks, but the magnitude of this link was larger for Blacks compared to Whites. Conclusion: Overall, marital status was differently linked to SRPM for Whites and Blacks. Accordingly, policymakers should be cautious while not assuming that diverse racial and ethnic groups with similar economic resources have similar health status.

Abstract Objective Minorities’ diminished returns theory suggests that socioeconomic status (SES) resources generate fewer health benefits for racial and ethnic minority groups, compared to the majority group. The current study aimed to compare Hispanic and non‐Hispanic white older adults for the association between educational attainment and poor physical self‐rated health (SRH). Methods The first wave of the University of Michigan National Poll on Healthy Aging (UM‐NPHA) included 1820 older adults who were 50‐80 years old and were either non‐Hispanic white (n = 1618) or Hispanic white (n = 202). The main independent variable of interest was educational attainment. The main dependent variable of interest was poor physical SRH. Gender, age, marital status, and employment status were covariates. Ethnicity was the focal effect modifier. Results Overall, higher level of educational attainment was associated with better physical SRH. A significant interaction was found between ethnicity and level of educational attainment, which was indicative of a smaller physical SRH gain due to high educational attainment for Hispanic white compared to non‐Hispanic white older adults. In ethnic‐specific models, we found evidence suggesting that high educational attainment reduced the odds of poor physical SRH for non‐Hispanic whites but not for Hispanic whites. Conclusion Compared to non‐Hispanic whites, Hispanic whites gain less physical SRH benefits from their educational attainment.

Purpose: According to the Minorities' Diminished Return (MDR) theory, socioeconomic status (SES) indicators such as employment status produce smaller tangible outcomes for racial and ethnic minority groups, however, very limited information exists on such diminished returns for Hispanics. To test whether MDR also holds for the social patterning of smoking behaviors among white adults, this study explored ethnic differences in the association between employment status and ever smoking in a representative sample of adults in Los Angeles. Methods: Los Angeles Family and Neighborhood Survey 2001 included 907 non-Hispanic white and 2117 Hispanic white adults (ages 18 or older). Ethnicity, gender, age, employment status, marital status, immigration status, and ever smoking were measured. Logistic regression models were used for data analysis. Results: In the pooled sample that included both non-Hispanic whites and Hispanic whites, being employed was associated with lower odds of ever smoking, net of covariates. A significant interaction was found between ethnicity and employment status on odds of ever smoking, suggesting a stronger inverse association between employment status and ever smoking for non-Hispanic whites than Hispanic whites. Ethnic specific models showed an inverse association between being employed and ever smoking status for non-Hispanic whites, but not for Hispanic whites. Conclusion: Even among whites, whether or not employment reduces the risk of ever smoking may depend on ethnicity, with Hispanics being at a disadvantage relative to non-Hispanic whites in terms of lower odds of ever smoking from their employment status.

Background and aims: As suggests by the Minorities’ Diminished Returns (MDR) theory, education attainment and other socioeconomic status (SES) indicators have a smaller impact on the health and well-being of non-White than White Americans. To test whether MDR also applies to happiness, in the present study, Blacks and Whites were compared in terms of the effect of education attainment on the level of happiness among American adults. Methods: General Social Survey (1972-2016) is a series of national surveys that are performed in the United States. The current analysis included 54785 adults (46724 Whites and 8061 Blacks). The years of schooling (i.e., education attainment) and happiness were the main independent variable and the main dependent variable of interest, respectively. In addition, other parameters such as gender, age, employment status, marital status, and the year of the survey were the covariates and race was the focal effect modifier. Finally, the logistic regression model was used to analyze the data. Results: Based on the results, high education attainment was associated with higher odds of happiness in the pooled sample. Further, a significant interaction was found between race and education attainment on the odds of happiness, showing a larger gain for Whites compared to Blacks. Racespecific models also confirmed this finding (i.e., a larger magnitude of the effect of education for Whites compared to Blacks). Conclusion: Overall, the MDR theory also applies to the effect of education attainment on happiness. Blacks’ disadvantage in comparison to the Whites in gaining happiness from their education may be due to the structural, institutional, and interpersonal racism and discrimination in the US. Therefore, there is a need for economic and public policies that can minimize the Blacks’ diminished returns of education attainment and other SES resources.

Abstract Objective As age is one of the main risk factors for lung cancer, older adults are expected to receive more messages regarding lung cancer screening (LCS). It is, however, unclear whether age similarly increases patients’ chance of discussing LCS across various racial groups. We aimed to determine racial differences in the effect of patients’ age on patient‐physician discussion about LCS. Methods This cross‐sectional study borrowed data from the Health Information National Trends Survey 5 (HINTS 2017), which included 2277 adults. Patients’ demographic factors, socioeconomic characteristics, smoking status, possible LCS indication, and patient‐physician discussion about LCS were measured. We ran logistic regression models for data analysis. Results Independent of possible LCS indication, older patients were more likely to have a patient‐physician discussion about LCS. However, there was a significant interaction between race and age, suggesting a larger effect of age on the likelihood of discussing LCS with doctors for Whites than Blacks. In race‐stratified models that controlled for possible LCS indication, higher age increased lung cancer discussion for Whites but not for Blacks. Conclusion Whether age increases the chance of discussing LCS or not depends on the patient's race, with Blacks receiving fewer messages regarding LCS as a result of their aging.

BackgroundConflict in Iraq has displaced millions of refugee youth. Warzone exposure and forced migration have unique acute and chronic impacts on youth, yet effects of exposure may not be universal across diverse refugee groups. Understanding how youth from various refugee groups are differentially affected by stress and trauma is critical to allocate resources and implement screening measures with the goal of providing early intervention.MethodTo identify the effects of warzone exposure and forced migration, a convenience sample of 48 Iraqi refugee youth ages 6–17 was assessed within the first month of arrival to the United States. Youth provided self-reported severity of posttraumatic stress and anxiety symptoms; symptom severity was then compared with an existing sample of 135 Syrian refugee youth to explore whether refugee youth of different nationalities experience the same effects of warzone exposure and forced migration. These data are the baseline for a longitudinal developmental study of refugee health, which also includes parental data.ResultsSeverity of separation anxiety and negative alterations in cognition and mood were the greatest symptomatic concerns in Iraqi refugee youth. Thirty-eight percent of responding Iraqi youth showed possible indication of an anxiety disorder. Severity of posttraumatic stress symptoms was lower in Iraqi youth compared to Syrian youth. For both Iraqi and Syrian refugee youth, separation anxiety was the most significant concern, with more than 80% of both samples showing a possible indication of clinically significant separation anxiety.ConclusionThe present observational study indicated that Iraqi refugee youth experience a range of anxiety and posttraumatic stress symptoms following warzone exposure and forced migration; posttraumatic stress symptoms were less severe in Iraqi versus Syrian youth. Comparing refugee youth of different nationalities is of particular importance, as our results demonstrate that findings from one refugee population cannot easily be generalized to another. Clinical and research efforts should prioritize interventions to address separation anxiety in refugee youth, which was of concern in both samples.

Objectives: Marginalization-related diminished returns (MDRs) refer to weaker health effects of educational attainment for socially marginalized groups compared to the socially privileged groups. Most of the existing literature on MDRs, however, has focused on marginalization due to race, ethnicity, and sexual orientation. Thus, very limited information exists on MDRs of educational attainment among immigrant populations in the United States.Aims: Building on the MDRs framework and using a nationally representative sample of US adults, we compared immigrant and native-born adults for the effects of educational attainment on psychological distress, self-rated health (SRH), and chronic diseases (CDs).Methods: The 2015 National Health Interview Survey (NHIS) has enrolled 33,672 individuals who were either immigrant (n = 6,225; 18.5%) or native born (n = 27,429; 81.5%). The independent variable (IV) was educational attainment, which was treated as a categorical variable. The dependent variables included psychological distress, SRH, and CDs, all of which were dichotomous variables. Age, gender, race, ethnicity, and region were confounders. Immigration (nativity status) was the moderator.Results: Higher educational attainment was associated with lower odds of psychological distress, poor SRH, and CDs. However, immigration showed a significant statistical interaction with college graduation on all outcomes, which were suggestive of smaller protective effects of college graduation on psychological distress, poor SRH, and CDs for immigrant than native-born adults.Conclusions: In the US, the associations between educational attainment and psychological distress, SRH, and CDs are all weaker for immigrant than native-born adults. To prevent health disparities, it is essential to decompose health inequalities that are due to low educational attainment from those that are due to diminished returns of educational attainment (i.e., MDRs). There is a need to help highly educated immigrant adults secure positive health outcomes, similar to their native-born counterparts. Such changes may require bold and innovative economic, public, and social policies that help immigrant adults to more effectively mobilize their educational attainment to secure tangible outcomes. Elimination of health disparities in the US requires efforts that go beyond equalizing access to education.

Background: High parent education is protective against youth health risk behaviors such as tobacco use. According to the Minorities' Diminished Returns theory, however, higher parent education seems to exert less protection for the ethnic minority relative to the majority groups.Objectives: To explore ethnic differences in the effects of parent education on the transition to cigarette smoking in a national sample of American never-smoker adolescents.Methods: This longitudinal study used data of waves 1 and 4 of the Population Assessment of Tobacco and Health (PATH 2013–2018). This analysis included 5,021 American youth who were never smokers at baseline (2013) and were followed for 4 years. Transition to cigarette smoking was the dependent variable. Parent education was the independent variable. Youth age, youth gender, and family structure were the covariates. Ethnicity was the moderating variable.Results: From the 5,021 American youth who were never smokers at baseline (2013), 89.4% continued as never smokers, and 10.6% became ever-smokers. Overall, 4.0% were current smokers at wave 4. Overall, a higher parent education was associated with lower odds of transitioning to ever and current cigarette smoker at the end of the 4th year. Parent education, however, showed significant interaction with Latino ethnicity on both outcomes suggesting smaller protective effects of high parent education against transitioning to tobacco use for Latino than for non-Latino youth.Conclusions: In the U.S., ethnicity alters the magnitude of the protective effect of parent education against youth transition to tobacco use. While high parent education is protective against transitioning to become a cigarette smoking overall, non-Latinos (a socially privileged group) gain more and Latino youth (a socially marginalized group) gain least from such a resource. In addition to addressing the SES gap, policymakers should identify and address mechanisms by which ethnic minority youth remain at risk of tobacco use, even when they are from highly educated families.

BackgroundYouth educational outcomes are a function of a wide range of factors including parental education level. This effect, however, is shown to be smaller for African American, Hispanic, and Asian American youth, a pattern called Marginalization-related Diminished Returns (MDRs). It is, however, unknown if it is race/ethnicity or other conditions associated with race/ethnicity (e.g., poor neighborhood quality) which reduces the marginal returns of parental education for youth.AimTo explore whether MDRs are only due to race/ethnicity or if they also remain for non-Hispanic Whites in poor neighborhoods, we compared the association between parental education level and adolescents’ school performance based on neighborhood quality in a nationally representative sample of non-Hispanic Whites in the United States.MethodsThis cross-sectional study used wave 1 of the Add Health study, an ongoing nationally representative cohort, 1994–2019. Participants included 849 non-Hispanic White adolescents between the ages of 12 and 21 years and their parents. The independent variable was parental education level, which was treated as a continuous measure. Age, grade, gender, and parental marital status were the covariates. The dependent variable was school performance (sum of school grades in Math, English, History, and Science). Linear regression models were used for data analysis.ResultsOverall, worse neighborhood quality was associated with worse school performance. Parental education level, however, was not directly associated with youth school performance. We found a statistically significant interaction between parental education level and neighborhood quality suggesting that the strength of the association between parental education and youth school performance weakens as neighborhood quality declines.ConclusionParental education level is a more salient determinant of youth educational outcomes in better neighborhoods. The result suggests that MDRs may not be solely due to race/ethnicity but contextual factors that commonly covary with marginalization and poverty. These contextual factors may include segregation, concentration of poverty, and social and physical neighborhood disorder.

Background: While financial difficulties correlate with mental and physical health status, less is known about these associations among economically disadvantaged African-American (AA) older adults.Objective: This study explored mental and physical health correlates of financial difficulties among AA older adults in low-income areas of south Los Angeles.Methods: A cross-sectional study on 740 AA older adults (age ≥ 55 years) conducted in South Los Angeles between 2015 and 2018. Independent variable was financial difficulties. Outcomes were depressive symptoms, chronic pain, chronic medical conditions, self-reported health, and sick days. Age, gender, educational attainment, living alone, marital status, smoking, and drinking were also measured. Zero order (unadjusted) and partial (adjusted) correlates of financial difficulties were calculated for data analysis. Adjusted (partial) bivariate correlations controlled for age, gender, education, marital status, living alone, and health insurance.Results: In adjusted analyses, financial difficulties were positively associated with chronic pain, chronic medical conditions, self-rated health, sick days, and depressive symptoms.Conclusion: Financial difficulties seem to be linked to chronic pain, chronic medical conditions, self-rated health, sick days, and depressive symptoms. The results advocate for evaluation of social determinants of health in providing health care of AA older adults. Addressing financial difficulties may help with the health promotion of low-income AA older adults in urban areas.

Objective: The positive effect of high socioeconomic position (SEP) on health is well established. According Minorities’ Diminished Returns (MDRs) theory, however, the SEP-health link is smaller for Blacks compared to Whites. Using a 25-year follow up data of a national sample, this study tested racial differences in the effects of marital status on life expectancy among American adults. Materials and methods: The data of Americans’ Changing Lives (ACL, 1986 – 2011) were used. The ACL is a nationally representative longitudinal cohort study followed 3,361 White or Blacks adults from 1986 to 2011. The predictor of interest was marital status in 1986. Confounders included demographic factors (age and gender), SEP (education and employment), health behaviors (drinking, smoking, and physical activity), and health status (depressive symptoms, chronic disease, and self-rated health) all measured at baseline. Race was the moderator variable. All-cause mortality was the main dependent variable (outcome). Cox proportional hazard modeling was applied for data analysis. Results: In the overall sample, individuals who were married at baseline had a lower risk of mortality during the 25 years of follow up. Race altered the effect of marital status on life expectancy, indicating smaller protective effect for Blacks relative to Whites. Race –specific Cox regression models showed an association between marital status and life expectancy for White but not Black Americans. Conclusion: In line with the MDRs theory, the health gain that follows marital status is diminished for Black Americans compared to White Americans. Only equalizing SEP across racial groups may not be adequate for eliminating racial/ethnic health inequalities. Policies should go beyond SEP and reduce societal and structural barriers that disproportionately hinder Blacks from translating their SEP indicators to desirable health outcomes.

Background and aims: Exposure and vulnerability to racial discrimination is not solely a function of race but the intersection of race and gender, with Black men experiencing more discrimination than Black women. This phenomenon is explained by the subordinate male target hypothesis, suggesting that majority of men specifically target men of color. If that is the case, implicit bias would be most common among the majority of men. The current cross-sectional study investigated race by gender differences in implicit bias against Blacks. Methods: Data came from Harvard University’s Project Implicit, an online survey, conducted during 2006-2016. Data included 444422 implicit association tests (IATs) which were taken by Blacks (n=56384) and Whites (n=388038). Using IAT, the dependent variable was implicit bias against Blacks. Independent variables were race, gender, and age. Using SPSS, linear regressions were utilized to test the additive and multiplicative effects of race and gender on implicit bias against Blacks. Results: Race (b = 0.39; 95% CI = 0.38-0.39) and gender (b = 0.05; 95% CI = 0.05-0.05) were associated with IAT score suggesting higher implicit bias against Blacks among Whites and men. A significant interaction was found between race and gender (b = 0.05; 95% CI = 0.04-0.07), suggesting the highest level of implicit bias against Blacks among White men. Conclusion: It is not solely race and gender but their intersection that shapes social distribution of implicit bias against Blacks. This finding extends the previous literature showing that not solely race or gender but their intersection influences exposure to discrimination.