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Policy Points Education-cognition research overlooks the role of education quality in shaping cognitive function at midlife and older ages, even though quality may be more responsive to federal and state investment in public schooling than attainment. For older US adults who attended school during the early to mid-20th century, the quality of US education improved considerably as federal and state investment increased. Ensuring access to high-quality primary and secondary education may protect against poor cognitive function at midlife and older ages, particularly among Black Americans and persons who complete less education. It may also play an important role in reducing health inequities. CONTEXT: Although educational attainment is consistently associated with better cognitive function among older adults, we know little about how education quality is related to cognitive function. This is a key gap in the literature given that the quality of US education improved considerably during the early to mid-20th century as state and federal investment increased. We posit that growing up in states with higher-quality education systems may protect against poor cognitive function, particularly among Black adults and adults who completed fewer years of school. METHODS: We used prospective data on cognitive function from the Health and Retirement Study linked to historical data on state investment in public schools, restricting our sample to non-Hispanic White and Black adults born between 1914 and 1959 (19,096 White adults and 4,625 Black adults). Using race-stratified linear mixed models, we considered if state-level education quality was associated with level and decline in cognitive function and if these patterns differed by years of schooling and race. FINDINGS: Residing in states with higher-resourced education systems during childhood was associated with better cognitive function, particularly among those who completed less than 12 years of schooling, regardless of race. For White adults, higher-resourced state education systems were associated with higher scores of total cognitive function and episodic memory, but there were diminishing returns as resources increased to very high levels. For Black adults, the relationship between state education resources and cognitive function varied by age with positive associations in midlife and generally null or negative associations at the oldest ages. CONCLUSIONS: Federal and state investment in public schools may provide students with opportunities to develop important cognitive resources during schooling that translate into better cognitive function in later life, especially among marginalized populations.
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Educational attainment is often considered the most important protective factor against cognitive impairment and dementia, yet significant variation in early educational experiences exists among midlife and older US adults. We used prospective data from the Health and Retirement Study (HRS) along with information on respondents' early educational experiences collected in the 2015 and 2017 HRS Life History Mail Survey to examine whether school context, educational content, and academic ability were associated with trajectories of cognitive functioning and whether educational attainment explains this relationship. We restricted our sample to age-eligible HRS Life History Mail Survey respondents who provided data on cognitive functioning at least once during 1998-2014 and attended primary school or higher (n = 9,565 respondents providing 62,037 person-period observations). Estimates from linear mixed models revealed that school context, educational content, and academic ability were significantly associated with level of cognitive functioning but not rate of cognitive decline. Educational attainment explained 9%-55% of the association between these early educational experiences and level of cognitive functioning; however, all relationships remained statistically significant. Our results suggest that educational experiences that span childhood and adolescence are independently related to level of cognitive functioning decades later.
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Éxito Académico , Cognición , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Estudios Prospectivos , Estados UnidosRESUMEN
BACKGROUND: Personal (i.e. egocentric) network characteristics are associated with health outcomes, including overweight and obesity. Previous research suggests educational attainment may interact with network characteristics to buffer these relationships. Limited research has examined the personal network characteristics of Black Americans, who have increased risk of overweight and obesity. The purpose of the current study was to examine associations between network characteristics and body mass index (BMI), and whether educational attainment modified these associations among Black Americans. METHODS: In 2014, using respondent-driven sampling, we recruited 430 adult residents of eight low-income neighborhoods in Greenville, SC. Self-administered questionnaires assessed structural and compositional characteristics (i.e. size, density) of respondents' personal networks, socio-demographic characteristics, and health-related behaviors and conditions. Multilevel regression models with robust sandwich estimation accounted for clustering within respondent chains. RESULTS: Among Black adults overall, network density-the number of connections among network members-was positively associated with BMI. Higher education moderated this relationship; among Black adults with a college degree, higher network density was inversely associated with BMI. CONCLUSIONS: Our data suggest low educational attainment may reflect more homogenous and less resourceful networks. Multiple pathways are discussed for how education interacts with network density on BMI among Black Americans.
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Negro o Afroamericano/psicología , Negro o Afroamericano/estadística & datos numéricos , Escolaridad , Sobrepeso/epidemiología , Sobrepeso/psicología , Apoyo Social , Adulto , Índice de Masa Corporal , Ego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pobreza , Análisis de Regresión , South Carolina/epidemiología , Encuestas y CuestionariosRESUMEN
Although immigrants are healthier than non-immigrants on numerous outcomes, the reverse appears to be true with regards to food insecurity. Most studies ignore heterogeneity in the risk for food insecurity within immigration status and by ethnicity, even though significant variation likely exists. We consider how immigration status and ethnicity are related to trends in food insecurity among Latinos and Asians in California from 2001 through 2011. Data come from the 2001 to 2011 restricted California Health Interview Survey (n=245,679). We categorized Latinos and Asians as US-born, naturalized/legal permanent residents (naturalized/LPR), and non-LPRs (students, temporary workers, refugees, and undocumented persons). Multivariable weighted logistic regression analyses assessed temporal trends over the 10-year period after adjustment for demographics, socioeconomic characteristics, and program participation. Across this period, US-born Asians reported similar levels of food insecurity as US-born Whites. Conversely, Latinos, regardless of immigration status or nativity, and Asian immigrants (i.e., naturalized/LPR and non-LPR) reported greater food insecurity than US-born Whites. Further, from 2001 through 2009, non-LPR Latinos reported higher risk of food insecurity than naturalized/LPR Latinos. Thus, food insecurity differs between ethnic groups, but also differs within ethnic group by immigration status. Efforts to reduce food insecurity should consider the additional barriers to access that are faced by immigrants, particularly those without legal permanent residency.
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Emigrantes e Inmigrantes/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Abastecimiento de Alimentos/estadística & datos numéricos , Pueblo Asiatico/estadística & datos numéricos , California , Femenino , Encuestas Epidemiológicas , Hispánicos o Latinos/estadística & datos numéricos , Humanos , MasculinoRESUMEN
Citizenship is both a system of privilege and a source of social identity. This study examines whether there are disparities in psychological distress between citizens and noncitizens, and whether these disparities may be explained by markers of social disadvantage (e.g., poverty, discrimination) or perceptions of success in the United States (i.e., subjective social status). We analyze data from the Asian subsample (n = 2,095) of the National Latino and Asian American Study. The data show that noncitizens report greater psychological distress compared with naturalized citizens and native-born citizens after accounting for sociodemographics (e.g., age, gender, Asian subgroup), socioeconomic characteristics (education, employment, income-to-poverty ratio), immigration (e.g., interview language, years in the United States, acculturative stress), health care visits, and everyday discrimination. Preliminary evidence suggests that subjective social status may explain some of the disparities between naturalized citizen and noncitizen Asian Americans.
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OBJECTIVES: We examined associations between sexual orientation and pregnancy risk among sexually experienced New York City high-school students. METHODS: We analyzed data from 2005, 2007, and 2009 New York City Youth Risk Behavior Surveys. We excluded students who had never engaged in sexual intercourse, only had same-gender sexual partners, or had missing data on variables of interest, resulting in a final sample of 4892 female and 4811 male students. We employed multivariable logistic regression to examine pregnancy risk by sexual orientation, measured as self-reported sexual identity and gender of sexual partners, with adjustment for demographics and sexual behaviors. We stratified analyses by gender. RESULTS: Overall, 14.3% of female and 10.8% of male students had experienced a pregnancy. Students who identified as gay, lesbian, or bisexual or reported both male and female sexual partners had higher odds of pregnancy than heterosexual students or students who only had opposite-gender sexual partners. Sexual behaviors accounted for higher odds of pregnancy among female, but only partially accounted for higher odds of pregnancy involvement among male, sexual-minority students. CONCLUSIONS: Sexual orientation should be considered in future adolescent pregnancy-prevention efforts, including the design of pregnancy-prevention interventions.
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Embarazo en Adolescencia/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Adolescente , Bisexualidad/estadística & datos numéricos , Niño , Femenino , Homosexualidad Femenina/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Ciudad de Nueva York/epidemiología , Embarazo , Embarazo en Adolescencia/psicología , Factores de Riesgo , Factores Sexuales , Estudiantes/psicología , Estudiantes/estadística & datos numéricosRESUMEN
OBJECTIVE: To date there is limited published evidence on the efficacy of tobacco control mass media campaigns in China. This study aimed to evaluate the impact of a mass media campaign 'Giving Cigarettes is Giving Harm' (GCGH) on Chinese smokers' knowledge of smoking-related harms and attitudes towards cigarette gifts. METHODS: Population-based, representative data were analysed from a longitudinal cohort of 3709 adult smokers who participated in the International Tobacco Control (ITC) China Survey conducted in six Chinese cities before and after the campaign. Logistic regression models were estimated to examine associations between campaign exposure and attitudes towards cigarette gifts measured post-campaign. Poisson regression models were estimated to assess the effects of campaign exposure on post-campaign knowledge, adjusting for pre-campaign knowledge. FINDINGS: Fourteen percent (n=335) of participants recalled the campaign within the cities where the GCGH campaign was implemented. Participants in the intervention cities who recalled the campaign were more likely to disagree that cigarettes are good gifts (71% vs 58%, p<0.01) and had greater levels of campaign-targeted knowledge than those who did not recall the campaign (mean=1.97 vs 1.62, p<0.01). Disagreeing that cigarettes are good gifts was higher in intervention cities than in control cities. Changes in campaign-targeted knowledge were similar in both cities, perhaps due to a secular trend, low campaign recall or contamination issues. CONCLUSIONS: These findings suggest that the GCGH campaign increased knowledge of smoking harms, which could promote downstream cessation. This study provides evidence to support future campaign development to effectively fight the tobacco epidemic in China.
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Conocimientos, Actitudes y Práctica en Salud , Cese del Hábito de Fumar/psicología , Fumar/psicología , Productos de Tabaco , Adulto , China , Estudios de Cohortes , Femenino , Donaciones , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Medios de Comunicación de Masas , Persona de Mediana Edad , Distribución de Poisson , Fumar/efectos adversos , Prevención del Hábito de FumarRESUMEN
Relatively few neighborhood-focused studies explicitly model the relationship between neighborhood change- i.e., racial change within a neighborhood-and individual mental health, instead focusing on the current composition of the neighborhood or on the outcomes of individuals that switch neighborhood contexts via moves. Further, while neighborhoods and schools are interconnected, researchers tend to focus on only one of these contexts in their work. Combining family and student data from the Panel Study of Income Dynamics (PSID) with multiple waves of neighborhood and school administrative data, our study extends current scholarship in this area by explicitly focusing on the relationship between exposure to neighborhood and school racial change-i.e., change occurring within the neighborhood or school in the prior decade-and the behavior problems of current students. We further analyze how associations vary: 1) by student race; 2) between newcomers to the neighborhood and those that lived in the neighborhood as it underwent demographic change; 3) and in neighborhoods with higher proportions of same-race residents. Our findings suggest that the relationship between local neighborhood contexts and the behavioral problems of children is nuanced and depends on the racial trajectories-change or stability-of neighborhoods, schools, and the interaction of both. Compared to longer-term residents, White newcomers tended to have more behavioral problems across racially changing and stable neighborhoods alike, regardless of the racial trajectories observed in the local school. Our results align with past work documenting the protective effect of same-race peers for Black children. Conversely, we find White students exhibit greater behavioral problems in settings with very high proportions of same-race peers, particularly in neighborhoods and schools that are simultaneously becoming increasingly racially isolated.
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Características de la Residencia , Instituciones Académicas , Humanos , Niño , Femenino , Masculino , Instituciones Académicas/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Problema de Conducta/psicología , Adolescente , Características del Vecindario/estadística & datos numéricos , Grupos Raciales/estadística & datos numéricos , Grupos Raciales/psicología , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Negro o Afroamericano/psicología , Estados UnidosRESUMEN
OBJECTIVE: Program planners work with promotoras (the Spanish term for female community health workers) to reduce health disparities among underserved populations. Based on the Role-Outcomes Linkage Evaluation Model for Community Health Workers (ROLES) conceptual model, we explored how program planners conceptualized the promotora role and the approaches and strategies they used to recruit, select, and sustain promotoras. DESIGN: We conducted semi-structured, in-depth interviews with a purposive convenience sample of 24 program planners, program coordinators, promotora recruiters, research principal investigators, and other individuals who worked closely with promotoras on United States-based health programs for Hispanic women (ages 18 and older). RESULTS: Planners conceptualized the promotora role based on their personal experiences and their understanding of the underlying philosophical tenets of the promotora approach. Recruitment and selection methods reflected planners' conceptualizations and experiences of promotoras as paid staff or volunteers. Participants described a variety of program planning and implementation methods. They focused on sustainability of the programs, the intended health behavior changes or activities, and the individual promotoras. CONCLUSION: To strengthen health programs employing the promotora delivery model, job descriptions should delineate role expectations and boundaries and better guide promotora evaluations. We suggest including additional components such as information on funding sources, program type and delivery, and sustainability outcomes to enhance the ROLES conceptual model. The expanded model can be used to guide program planners in the planning, implementing, and evaluating of promotora health programs.
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Planificación en Salud Comunitaria , Agentes Comunitarios de Salud/organización & administración , Atención a la Salud/organización & administración , Selección de Paciente , Salud de la Mujer , Adolescente , Adulto , Femenino , Promoción de la Salud , Disparidades en Atención de Salud , Hispánicos o Latinos , Humanos , Entrevistas como Asunto , Masculino , Obesidad/prevención & control , Rol , Estados Unidos , Adulto JovenRESUMEN
Training is an essential component of health programs that incorporate promotoras de salud (the Spanish term for community health workers) in the delivery of health education and behavioral interventions to Hispanics. During training sessions, promotoras are exposed to information and skill-building activities they need to implement the health programs. This analysis was one component of a broader study which explored program planners' approaches to recruiting and training promotoras to deliver and sustain health promotion programs for Hispanic women. The purpose of this study was to examine promotora-curriculum and training processes used to prepare promotoras to deliver health programs. The authors examined transcripts of 12 in-depth interviews with program planners and conducted a content analysis of seven different training materials used in their respective promotora programs. Interview themes and narratives included program planners' varying conceptualizations of promotora-training, including their personal definitions of "training the trainer," the practice of training a cadre of promotoras before selecting those best fit for the program, and the importance of providing goal-directed, in-depth training and supervision for promotoras. The content analysis revealed a variety of strategies used to make the training materials interactive and culturally competent. Study implications describe the importance of planners' provision of ongoing, goal-directed, and supervised training using both appropriate language and interactive methods to engage and teach promotoras.
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Agentes Comunitarios de Salud/educación , Promoción de la Salud/métodos , Competencia Cultural , Curriculum , Femenino , Hispánicos o Latinos , Humanos , Entrevistas como Asunto , Enseñanza/métodosRESUMEN
Racial health inequities persist despite many attempts to correct them. Inadequate comprehension of racism obscures the ordinariness of racism in public health institutions. In addition to applying critical race theory (CRT) to the research and practice of public health, we argue that the struggle for health equity must also apply CRT toward the teaching of public health students. Adhering to conventional approaches in academic public health without grappling with their roots in Whiteness reproduces a public health workforce that is insufficiently equipped to address the complex, systemic issues underlying health inequities. By default, academic public health excludes the perspectives of scholars of color, relies too heavily on theories of individual behavior, and applies top-down teaching methods. To make durable changes, the rising generation of public health scholars and practitioners must understand how health equity fits within broader struggles for racial and social justice. Thus, we critique three responsibilities for teaching about public health: assigning readings, shaping analytical lenses with theories, and modeling change through andragogy. By questioning whose knowledge is legitimized when defining public health needs, whose lenses are used to prioritize solutions, and whose insights drive change, we can train a public health workforce more critical of racism, and more prepared to deal with the enduring reality of racial relations.
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Equidad en Salud , Racismo , Humanos , Disparidades en el Estado de Salud , Justicia Social , Población BlancaRESUMEN
RATIONALE: Black adults experience worse cognitive function than their White peers. Although educational attainment is an important predictor of cognitive function, other aspects of education, including school desegregation, may also shape this relationship. For Black adults who grew up in the U.S. South in the 1950s-1970s, exposure to school desegregation may have altered life course pathways critical for later cognitive function. OBJECTIVE: We determined if state variation in exposure to school desegregation in the U.S. South was associated with cognitive function at mid-life, if the association varied by race, and if the association remained after adjustment for state-level education quality and respondents' educational attainment. METHODS: We linked historical data on state-level school desegregation to the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older. We restricted our sample to Black (n = 1443) and White (n = 1507) adults born between 1948 and 1963 who resided in the U.S. South during primary school. We assessed three cognition outcomes: total cognitive function, episodic memory, and mental status. We estimated race-stratified linear regression models with cluster adjustment and a final model using state fixed effects. RESULTS: Greater exposure to desegregated primary schooling was associated with higher cognitive function and episodic memory among Black but not White adults. Among Black adults, the association between school desegregation and cognitive function and episodic memory remained after adjustment for state-level education quality and educational attainment. CONCLUSIONS: Our findings suggest that state-level school desegregation efforts played a consequential role in shaping the cognitive function of Black adults who grew up in the U.S. South.
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Cognición , Desegregación , Anciano , Humanos , Persona de Mediana Edad , Negro o Afroamericano , Blanco , Estados Unidos , Sudeste de Estados UnidosRESUMEN
Federal legislation and judicial intervention led to significant transformation in the U.S. education system during the early to mid-20th century. These changes may differentiate older adults in their experiences of aging, particularly at the intersection of race, gender, and cohort, but are not well documented among current cohorts of older adults. Our study addresses this gap by providing rich, descriptive information on the educational experiences of U.S. adults who attended primary or secondary school between 1915 and 1977. We used data from the Health and Retirement Study (HRS), a nationally representative, prospective study of U.S. adults over age 50 years. The HRS collected information on respondents' schooling history and experiences through a Life History Mail Survey (LHMS). We restricted our sample to age-eligible HRS-LHMS respondents who self-identified as non-Hispanic White or non-Hispanic Black and completed at least 75% of their primary or secondary schooling in the U.S. (n=10,632). Educational experiences, defined as pre-k to post-secondary education, varied across cohort, regardless of race or gender. Greater course offerings, improvements in learning support, and increasing exposure to integrated schools occurred across successive cohorts. We found the highest rates of enrollment in college preparatory curriculum and foreign-language courses as well as diagnosed learning differences in cohorts born after 1948. Among White adults, many of the gender differences in educational experiences documented in the oldest cohort were still found among the most recent cohort. Few gender differences, however, were found for Black adults regardless of cohort. Conversely, most race inequities in educational experiences persisted. Such inequities may be an important source of continued differences in experiences of aging observed across demographic groups.
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OBJECTIVES: We examined associations among 3 dimensions of sexual orientation (identity, behavior, and attraction) and key health-related indicators commonly studied among sexual minority populations: depressive symptoms, perceived stress, smoking, binge drinking, and victimization. METHODS: We analyzed data from the National Longitudinal Study of Adolescent Health, Wave IV (2007-2008) when respondents were aged 24 to 32 years (n=14,412). We used multivariate linear and logistic regressions to examine consistency of associations between sexual orientation measures and health-related indicators. RESULTS: Strength of associations differed by gender and sexual orientation measure. Among women, being attracted to both sexes, identifying as "mostly straight" or "bisexual," and having mostly opposite-sex sexual partners was associated with greater risk for all indicators. Among men, sexual attraction was unrelated to health indicators. Men who were "mostly straight" were at greater risk for some, but not all, indicators. Men who had sexual partners of the same-sex or both sexes were at lower risk for binge drinking. CONCLUSIONS: Using all 3 dimensions of sexual orientation provides a more complete picture of the association between sexual orientation and health among young adults than does using any 1 dimension alone.
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Alcoholismo/epidemiología , Víctimas de Crimen/estadística & datos numéricos , Depresión/epidemiología , Estado de Salud , Conducta Sexual/estadística & datos numéricos , Fumar/epidemiología , Estrés Psicológico/epidemiología , Adulto , Bisexualidad/estadística & datos numéricos , Femenino , Heterosexualidad/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Estudios Longitudinales , Masculino , Análisis Multivariante , Análisis de Regresión , Factores Sexuales , Adulto JovenRESUMEN
OBJECTIVES: We examined whether attaining a higher educational degree after 25 years of age was associated with fewer depressive symptoms and better self-rated health at midlife than was not attaining a higher educational degree. METHODS: We analyzed data from National Longitudinal Survey of Youth, restricting our sample to respondents who had not attained a bachelor's degree by 25 years of age (n = 7179). We stratified all regression models by highest degree attained by 25 years of age. RESULTS: Among respondents with no degree, a high school diploma, or a post-high school certificate at 25 years of age, attaining at least a bachelor's degree by midlife was associated with fewer depressive symptoms and better self-rated health at midlife compared with respondents who did not attain a higher degree by midlife. Those with an associate's degree at 25 years of age who later attained a bachelor's degree or higher reported better health at midlife. CONCLUSIONS: Attaining at least a bachelor's degree after 25 years of age is associated with better midlife health. Other specifications of educational timing and its health effects across the life course should be studied.
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Depresión/fisiopatología , Estado de Salud , Autorrevelación , Adulto , Escolaridad , Femenino , Humanos , Estudios Longitudinales , Masculino , Análisis de Regresión , Factores de Tiempo , Estados Unidos , Adulto JovenRESUMEN
Recent studies show that racism may influence health inequities. As individuals grow from infancy into old age, they encounter social institutions that may create new exposures to racial bias. Yet, few studies have considered this idea fully. We suggest a framework that shows how racism and health inequities may be viewed from a life course perspective. It applies the ideas of age-patterned exposures, sensitive periods, linked lives, latency period, stress proliferation, historic period, and cohorts. It suggests an overarching idea that racism can structure one's time in asset-building contexts (e.g., education) or disadvantaged contexts (e.g., prison). This variation in time and exposure can contribute to racial inequities in life expectancy and other health outcomes across the life course and over generations.
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Disparidades en el Estado de Salud , Prejuicio , Factores de Edad , Humanos , Medio Social , Estrés Psicológico/etnologíaRESUMEN
OBJECTIVES: Race/ethnicity and education are among the strongest social determinants of body mass index (BMI) throughout the life course, yet we know relatively little about how these social factors both independently and interactively contribute to the rate at which BMI changes from adolescence to midlife. The purpose of this study is to (1) examine variation in trajectories of BMI from adolescence to midlife by mothers' and respondents' education and (2) determine if the effects of mothers' and respondents' education on BMI trajectories differ by race/ethnicity and gender. DESIGN: We used nationally representative data from the National Longitudinal Survey of Youth. Our sample included white (n=4433), black (n=2420), and Hispanic (n=1501) respondents. Self-reported height and weight were collected on 16 occasions from 1981 to 2008. We employed two-level linear growth models to specify BMI trajectories. RESULTS: Mothers' education was inversely associated with BMI and BMI change among women. Among men, mothers' education was inversely associated with BMI; these educational disparities persisted for whites, diminished for blacks, and widened for Hispanics. Respondents' education was inversely associated with BMI among women, but was positively associated with the rate of BMI change among black women. Respondents' education was inversely associated with BMI among white and Hispanic men, and positively associated with BMI among black men. These educational disparities widened for White and Black men, but narrowed for Hispanic men. CONCLUSIONS: Our results suggest that by simultaneously considering multiple sources of stratification, we can more fully understand how the unequal distribution of advantages or disadvantages across social groups affects BMI across the life course.
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Envejecimiento , Índice de Masa Corporal , Etnicidad/estadística & datos numéricos , Padres , Grupos Raciales , Factores Sexuales , Adulto , Factores de Edad , Escolaridad , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Responsabilidad Parental , Factores de Riesgo , Autoinforme , Estadística como Asunto , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: To investigate the association between religious involvement and cognitive functioning at the intersections of race-ethnicity and gender among midlife and older adults, and to determine if psychosocial factors help explain this relationship. METHOD: The sample included 14,037 adults aged 50+ from the Health and Retirement Study (HRS). We utilized measures from the HRS 2010 and 2012 Core interviews and Leave-Behind questionnaires and estimated our models using linear regression. RESULTS: Compared to individuals who frequently attended religious services, infrequent religious service attendance was related to poorer cognitive functioning. Religiosity was inversely associated with cognitive functioning at baseline, but the relationship varied by race/gender subgroup. Greater religiosity was associated with better cognitive functioning among Black women, but lower cognitive functioning among White men and women. Psychosocial factors did little to explain the inverse association between religiosity and cognitive functioning. DISCUSSION: Results suggest the association between religious involvement and cognitive functioning is varied and complex, and largely dependent on important social identities. The findings have important implications for investigating health-protective factors, like religious involvement, using an intersectional perspective.
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Envejecimiento/etnología , Negro o Afroamericano/etnología , Cognición/fisiología , Religión y Psicología , Población Blanca/etnología , Anciano , Anciano de 80 o más Años , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Estados Unidos/etnologíaRESUMEN
OBJECTIVES: This article focuses on the older Latino undocumented population and anticipates how their current demographic characteristics and health insurance coverage might affect future population size and health insurance trends. METHODS: We use the 2013-2018 American Community Survey as a baseline to project growth in the Latino 55 and older undocumented population over the next 20 years. We use the cohort component method to estimate population size across different migration scenarios and distinguish between aging in place and new immigration. We also examine contemporary health insurance coverage and chronic health conditions among 55 and older undocumented Latinos from the 2003-2014 California Health Interview Survey. We then project health insurance rates in 2038 among Latino immigrants under different migration and policy scenarios. RESULTS: If current mortality, migration, and policy trends continue, projections estimate that 40% of undocumented Latino immigrants will be 55 years or older by 2038-nearly all of whom will have aged in place. Currently, 40% of older Latino undocumented immigrants do not have insurance. Without policies that increase access to insurance, projections estimate that the share who are uninsured among all older Latinos immigrants will rise from 15% to 21%, and the share who is both uninsured and living with a chronic health condition will rise from 5% to 9%. DISCUSSION: Without access to health care, older undocumented immigrants may experience delayed care and more severe morbidity. Our projections highlight the need to develop and enact policies that can address impending health access concerns for an increasingly older undocumented Latino population.
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Enfermedad Crónica/etnología , Accesibilidad a los Servicios de Salud , Hispánicos o Latinos/estadística & datos numéricos , Seguro de Salud/tendencias , Inmigrantes Indocumentados/estadística & datos numéricos , Anciano , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/tendencias , Necesidades y Demandas de Servicios de Salud , Humanos , Cobertura del Seguro , Masculino , Persona de Mediana Edad , Pronóstico de Población , Estados Unidos/epidemiologíaRESUMEN
Although recent studies report a decline in dementia prevalence among U.S. older adults, national trends may mask subnational variation, particularly given large health and social inequalities linked to geography. To address this gap, we determined if there was subnational variation in reported national dementia trends and if region-specific trends were explained by sociodemographic and health characteristics. Data come from the 2000 (n = 10,447) and 2012 (10,426) waves of the Health and Retirement Study. We used validated methods for dementia classification using proxy and self-respondents. Logistic regression models, adjusted for within-person clustering over time, estimated trends in dementia prevalence by region and census division. We found subnational variation in dementia prevalence in both 2000 and 2012, as well as in change in dementia prevalence during this period. In 2000, dementia prevalence was lowest in the West (8.6%), higher in the Midwest (10.0%) and Northeast (11.1%), and highest in the South (14.6%). Dementia prevalence declined over time across all regions of the U.S. from 2000 to 2012 but remained highest in the South (10.7%) compared to the other regions (7.0-7.8%). Despite downward trends in dementia across the U.S., the prevalence of dementia in the South in 2012 approximated levels found in other regions in 2000. There was relatively less change over time in the West compared to other regions, but dementia prevalence was already quite low in the West in 2000. Within region, trends in dementia prevalence between 2000 and 2012 also varied slightly across census divisions. Subnational variation in changes in dementia prevalence were largely explained by education and health status. Variation in baseline prevalence, as well as differential rates of change, highlight the importance of examining subnational variation in dementia trends.