"Hang Ups, Let Downs, Bad Breaks, Setbacks": Impact of Structural Socioeconomic Racism and Resilience on Cognitive Change Over Time for Persons Racialized as Black.

Introduction: Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies. Methods: We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models. Results: Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts. Discussion: These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.

Decomposing interaction and mediating effects of race/ethnicity and circulating blood levels of cystatin C on cognitive status in the United States health and retirement study.

Background and objectives: Elevated circulating cystatin C is associated with cognitive impairment in non-Hispanic Whites, but its role in racial disparities in dementia is understudied. In a nationally representative sample of older non-Hispanic White, non-Hispanic Black, and Hispanic adults in the United States, we use mediation-interaction analysis to understand how racial disparities in the cystatin C physiological pathway may contribute to racial disparities in prevalent dementia. Methods: In a pooled cross-sectional sample of the Health and Retirement Study (n = 9,923), we employed Poisson regression to estimate prevalence ratios and to test the relationship between elevated cystatin C (>1.24 vs. ≤1.24 mg/L) and impaired cognition, adjusted for demographics, behavioral risk factors, other biomarkers, and chronic conditions. Self-reported racialized social categories were a proxy measure for exposure to racism. We calculated additive interaction measures and conducted four-way mediation-interaction decomposition analysis to test the moderating effect of race/ethnicity and mediating effect of cystatin C on the racial disparity. Results: Overall, elevated cystatin C was associated with dementia (prevalence ratio [PR] = 1.2; 95% CI: 1.0, 1.5). Among non-Hispanic Black relative to non-Hispanic White participants, the relative excess risk due to interaction was 0.7 (95% CI: -0.1, 2.4), the attributable proportion was 0.1 (95% CI: -0.2, 0.4), and the synergy index was 1.1 (95% CI: 0.8, 1.8) in a fully adjusted model. Elevated cystatin C was estimated to account for 2% (95% CI: -0, 4%) for the racial disparity in prevalent dementia, and the interaction accounted for 8% (95% CI: -5, 22%). Analyses for Hispanic relative to non-white participants suggested moderation by race/ethnicity, but not mediation. Discussion: Elevated cystatin C was associated with dementia prevalence. Our mediation-interaction decomposition analysis suggested that the effect of elevated cystatin C on the racial disparity might be moderated by race/ethnicity, which indicates that the racialization process affects not only the distribution of circulating cystatin C across minoritized racial groups, but also the strength of association between the biomarker and dementia prevalence. These results provide evidence that cystatin C is associated with adverse brain health and this effect is larger than expected for individuals racialized as minorities had they been racialized and treated as non-Hispanic White.

Sexual Health Experiences Among High School Students With Disabilities.

PURPOSE: The purpose of this study was to investigate the sexual experiences of adolescents with and without disabilities. METHODS: Data were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. We compared teens with and without disabilities on whether or not they had ever had sexual intercourse (N = 20,812). Among those who had ever had intercourse (N = 8,311), we used multivariable Poisson regression to measure the association between disability status and the prevalence of five sexual experiences. RESULTS: After adjusting for sociodemographic characteristics, the prevalence of ever having had intercourse was 25% higher among teens with disabilities than among those without (adjusted prevalence ratio [aPR] 1.25, 95% confidence interval [CI]: 1.20-1.30). Among students who had had intercourse, the prevalence of having had intercourse before the age of 15 years (aPR 1.25, 95% CI: 1.14-1.47), having ≥ 2 lifetime sexual partners (aPR 1.13, 95% CI 1.07-1.19), having ≥ 2 sexual partners in the previous three months (aPR 1.23, 95% CI: 1.00-1.52), having used alcohol and/or drugs at the last intercourse (aPR 1.28, 95% CI: 1.10-1.48), and having condomless sex at the last intercourse (aPR 1.17, 95% CI: 1.08-1.27) was higher among students with disabilities than among students without disabilities. After accounting for sexual abuse, each of these associations was attenuated and most were no longer significant. CONCLUSIONS: Youth with disabilities are sexually active. Findings highlight the need for increased attention to sexual abuse prevention, sexual health promotion, and risk reduction efforts for this population.

CSA Partnerships for Health: outcome evaluation results from a subsidized community-supported agriculture program to connect safety-net clinic patients with farms to improve dietary behaviors, food security, and overall health.

Safety-net clinic patients are at risk for food insecurity, which is associated with poor diet quality and negative health outcomes. Research on the impact of interventions addressing food insecurity in health care settings is limited. The primary aim of this study was to determine the preliminary effectiveness of Community-Supported Agriculture (CSA) Partnerships for Health, a 23 week grant-subsidized CSA program, in improving dietary behaviors, self-efficacy to eat vegetables, food security, and overall health among safety-net clinic patients. This single-group pretest-posttest study used interviewer-administered surveys. Study participants were 48 safety-net clinic patients. Outcomes included fruit and vegetable intake, frequency of dark green and orange vegetable intake, self-efficacy to eat vegetables, eating habits, food security status and ability to afford to eat healthy meals, emotional health, social health, and general health status. Differences in values at postintervention versus preintervention were examined using two-sided paired t-tests, McNemar's tests, and generalized estimating equation models. The difference between postintervention versus preintervention values was statistically significant for a number of outcomes, including vegetable intake (p = .030), orange vegetable intake (p = .004), eating habits (p = .039), food security (p = .039), ability to afford to eat healthy meals (p = .003), and general health status (p = .039). Generalized estimating equation models showed similar associations. CSA Partnerships for Health may have the potential to improve dietary behaviors, reduce food insecurity, and improve overall health among safety-net clinic patients.

Application of an intersectional framework to understanding the association of disability and sexual orientation with suicidal ideation among Oregon Teens.

BACKGROUND: Suicide is the second leading cause of death among U.S. youth. Prior research has found that disability and sexual orientation are each independently associated with suicide risk. However, most analyses regarding sexual orientation or disability in relation to teenagers' health have isolated the effects of these identities via multiple regression models. That approach assumes there is no multiplicative or synergistic effect between the two identities. OBJECTIVE: To examine the association between suicidal ideation and the intersection of disability and sexual orientation. METHODS: Cross-sectional data from the 2015 Oregon Healthy Teens Survey were analyzed using Poisson regression analysis with robust variance to estimate the relationship between the intersection of disability and sexual orientation and youth reports of suicidal ideation. We calculated three measures of interaction: 1) the excess risk due to interaction (RERI); 2) the proportion attributable to interaction (AP); and 3) the synergy index (SI). RESULTS: Sexual minority teenagers with disabilities had higher risk of suicidal ideation (adjusted relative risk [ARR] = 2.82, 95% CI: 2.47-3.21) with respect to heterosexual teenagers without disabilities. The risk was also elevated, to a lesser degree, for heterosexual youth with disabilities (ARR = 1.97, 95% CI: 1.78-2.19) and LGB youth without disabilities (ARR = 2.17, 95% CI: 1.95-2.42) with respect to the reference group. Our measures of interaction were indicative of a synergistic effect between disability and sexual orientation. CONCLUSIONS: Our findings suggest the combination of disability and minority sexual orientation may be associated with compounded negative experiences that could exacerbate the risk of suicide.