Working Through It: Lifetime Experiences of Employment Discrimination Among Older Black Americans and Implications for Labor Force Participation, Job Dissatisfaction, and Mental Health in Older Adulthood.

OBJECTIVES: To examine lifetime experiences of employment discrimination and their association with Black older adults' employment status and well-being. METHODS: We use data from the Health and Retirement Study's leave-behind questionnaire to characterize lifetime experiences of being unfairly fired, not hired, or not promoted among Black older adults (N = 2948) and test associations with labor force status at age 62, job satisfaction among those working, and depressive symptoms. RESULTS: Employment discrimination was commonly reported by Black older adults, especially among men and those with college educations. Employment discrimination was not associated with employment status at age 62 but was associated with job dissatisfaction (OR = 2.00, p = .001) and depressive symptoms (Beta = 0.34, p < .001). DISCUSSION: Findings suggest a negative association between employment discrimination at any point in the life course and Black older adults' well-being. Employment discrimination is an obstacle to healthy aging, yet improved discrimination survey items are needed to fully capture its impact on Black Americans.

The "double jeopardy" of midlife and old age mortality trends in the United States.

Since 2010, US life expectancy growth has stagnated. Much research on US mortality has focused on working-age adults given adverse trends in drug overdose deaths, other external causes of death, and cardiometabolic deaths in midlife. We show that the adverse mortality trend at retirement ages (65+ y) has in fact been more consequential to the US life expectancy stagnation since 2010, as well as excess deaths and years of life lost in 2019, than adverse mortality trends at working ages. These results reveal that the United States is experiencing a "double jeopardy" that is driven by both mid-life and older-age mortality trends, but more so by older-age mortality. Understanding and addressing the causes behind the worsening mortality trend in older ages will be essential to returning to the pace of life expectancy improvements that the United States had experienced for decades.

Quantifying the Contribution of Work Characteristics to Educational Disparities in Health-Induced Work Limitations.

OBJECTIVES: To quantify how poor health and inhospitable working conditions each contribute to educational disparities in work disability in midlife and old age. METHODS: We used the Health and Retirement Study (2006-2016) to examine educational disparities in reporting "any impairment or health problem that limits the kind or amount of paid work" in ages 51-80. RESULTS: We found disparities to be profound and persistent over time. Blinder-Oaxaca threefold decomposition revealed that distributions of income and employer insurance made the largest contribution to explaining different rates of work limitations among respondents with versus without high school degrees, followed by work characteristics (physical job demands, insufficient hours) and health conditions (diabetes, lung disease). Comparing respondents with high school versus college degrees, distributions of health conditions mattered most (high blood pressure, lung disease, heart disease, stroke), followed by health behaviors (smoking, drinking). Health-induced work limitations are often used as a measure of health, but we found that work characteristics explained 57% of the disadvantage of those without a high school degree and 44% of the disadvantage of high school compared to college graduates. DISCUSSION: Work environments appear to play an important role in educational disparities in mid- to late-life disability.

Work at Age 62: Expectations and Realisations among Recent Cohorts of Americans.

Much remains unknown about how the 2008 Great Recession, coupled with the ageing baby boomer cohort, have shaped retirement expectations and realized retirement timing across diverse groups of older Americans. Using the Health and Retirement Study (1992-2016), we compared expectations about full-time work at age 62 (reported at ages 51-61) with realized labor force status at age 62. Of the 12,049 respondents, 34 per cent reported no chance of working full time at 62 (zero probability) and 21 per cent reported it was very likely (90-100 probability). Among those reporting no chance of working, there was a 0.111 probability of unmet expectations; among those with high expectations of working, there was a 0.430 probability of unmet expectations. Black and Hispanic Americans were more likely than whites to have unmet expectations of both types. Educational attainment was associated with higher probability of unexpectedly working and lower probability of unexpectedly not working. Baby boomers experienced fewer unmet expectations than prior cohorts but more uncertainty about work status at 62. Our findings highlight the unpredictability of retirement timing for significant segments of the U.S. population and the role of the Great Recession in contributing to uncertainty. Given the individual and societal benefits of long work lives, special attention should be paid to the high rates of unexpectedly not working at age 62.

Older Workers With Unpredictable Schedules: Implications for Well-Being and Job Retention.

BACKGROUND AND OBJECTIVES: A substantial portion of the service sector workforce is middle-aged or older, but little is known about the scheduling conditions of these older workers. This study describes the quality of work schedules in the service sector by age and tests associations of unpredictable schedules with well-being and job retention among workers ages 50-80. RESEARCH DESIGN AND METHODS: The Shift Project collected survey data on detailed working conditions and health from 121,408 service sector workers, recruited in 2017-2020 using social media advertisements. Survey weights aligned sample demographics with the American Community Survey, and multiple imputation addressed missingness. Ordinary least squares regression models were used to examine associations between age and schedule stability, and ordinary least squares, ordinal logit, and logit regression models tested associations between schedule stability and well-being and job retention outcomes for older workers. RESULTS: Scheduling conditions were more stable and predictable for older compared to younger workers; however, more than 80% of workers ages 50-80 experienced one or more types of routine schedule instability. Among workers ages 50-80, unpredictable schedules were associated with psychological distress, poor-quality sleep, work-family conflict, economic insecurity, job dissatisfaction, and intentions to look for a new job. Canceled and back-to-back closing and opening ("clopening") shifts were most strongly associated with negative outcomes. DISCUSSION AND IMPLICATIONS: Policies aimed at improving scheduling conditions hold promise to benefit older service workers' well-being. As the population ages, improving work schedules in the years approaching retirement may be important to longer working lives.

The growing rural-urban divide in US life expectancy: contribution of cardiovascular disease and other major causes of death.

BACKGROUND: The US rural disadvantage in life expectancy (LE) relative to urban areas has grown over time. We measured the contribution of cardiovascular disease (CVD), drug-overdose deaths (DODs) and other major causes of death to LE trends in rural and urban counties and the rural-urban LE gap. METHODS: Counterfactual life tables and cause-of-death decompositions were constructed using data on all US deaths in 1999-2019 (N = 51 998 560) from the Centers for Disease Control and Prevention. RESULTS: During 1999-2009, rural and urban counties experienced robust LE gains, but urban LE increased by 1.19 years more in women and 0.86 years more in men compared with rural LE. During 2010-2019, rural counties experienced absolute declines in LE (women -0.20, men -0.30 years), whereas urban counties experienced modest increases (women 0.55, men 0.29 years). Counterfactual analysis showed that slowed CVD-mortality declines, particularly in ages 65+ years, were the main reason why rural LE stopped increasing after 2010. However, slow progress in CVD-mortality influenced LE trends more in urban areas. If CVD-mortality had continued to decline at its pre-2010 pace, the rural-urban LE gap would have grown even more post 2010. DODs and other causes of death also contributed to the LE trends and differences in each period, but their impact in comparison to that of CVD was relatively small. CONCLUSIONS: Rural disadvantage in LE continues to grow, but at a slower pace than pre 2010. This slowdown is more attributable to adverse trends in CVD and DOD mortality in urban areas than improvements in rural areas.

Unmet Expectations About Work at Age 62 and Depressive Symptoms.

OBJECTIVES: Exiting the labor force earlier or later than planned is common, with predictable economic consequences. However, the mental health ramifications of such off-time events are not known but are important to promoting well-being in retirement. METHODS: Using the Health and Retirement Study (1992-2016), we created 6 groups based on the alignment of expectations about full-time work at age 62 (reported at ages 51-61) with realized labor force status after reaching age 62 (N = 10,421). Negative binomial models estimated the adjusted association between unmet expectations about work and depressive symptoms. RESULTS: Unexpectedly not working was associated with higher depressive symptoms than working as expected after adjusting for sociodemographic, economic, and health factors at the time of expectations (incidence rate ratio = 1.35, 95% confidence interval: 1.17-1.56). Additionally, adjusting for health declines and marriage dissolution between expectations and age 62 partially attenuated the association, but unexpectedly not working remained significantly associated with a 1.16 increase in the incidence rate of depressive symptoms. Unexpectedly working at 62 was not associated with depressive symptoms. Race/ethnicity interacted with expectation alignment (F(15,42) = 2.44, p = .0118) in that Hispanic respondents experienced an increase in depressive symptoms when working after unmet and unsure expectations compared to met expectations, whereas White respondents did not. DISCUSSION: Unlike working longer than expected, unexpectedly not working at age 62 was associated with depressive symptoms, even after accounting for health declines. Public and employer policies should assist workers in remaining in the labor force as long as planned and offer mental health supports for unexpected work exits.

Job Transitions and Mental Health Outcomes Among U.S. Adults Aged 55 and Older During the COVID-19 Pandemic.

OBJECTIVES: Adults around retirement age are especially vulnerable to the effects of the recent economic downturn associated with coronavirus disease 2019 (COVID-19). This study investigated disturbances to working life and mental health among Americans aged at least 55 during the early months of the pandemic. METHODS: Using data from the nationwide COVID-19 Coping Study (N = 6,264), we examined rates of job loss, furloughs, hour/income reductions, and work from home, along with unchanged work status, by age, gender, race/ethnicity, educational attainment, and occupation. We next described sources of worry by job transition group and tested the adjusted associations of COVID-19-related job transitions with life satisfaction, loneliness, depressive symptoms, and anxiety symptoms. RESULTS: Most job losses occurred among respondents younger than age 65 and those without college degrees. Job loss and reduced hours/income were more common among Hispanics compared to other racial/ethnic groups, and work from home transitions were most common among respondents with high educational attainment and jobs in government- and education-related occupations. Workers who lost their jobs had the lowest life satisfaction and the highest loneliness and depressive symptoms, followed by workers who were furloughed and workers with reduced hours/income. Work from home was associated with more anxiety than unchanged work. DISCUSSION: COVID-19-related job transitions are detrimental to mental health, even when they might keep workers safe. These results enhance our understanding of the potentially long-term mental health effects of social and economic aspects of the COVID-19 pandemic and highlight the need for economic and mental health support for aging Americans.

Skilled Nursing Facilities Modify the Relationship Between Depressive Symptoms and Hospital Readmissions but Not Health Outcomes Among Older Adults.

Objectives: Despite detrimental effects of depressive symptoms on self-care and health, hospital discharge practices and the benefits of different discharge settings are poorly understood in the context of depression. Methods: This retrospective cohort study comprised 23,485 hospitalizations from Medicare claims linked to the Health and Retirement Study (2000-2014). Results: Respondents with depressive symptoms were no more likely to be referred to home health, whereas the probability of discharge to skilled nursing facilities (SNFs) went up a half percentage point with each increasing symptom, even after adjusting for family support and health. Rehabilitation in SNFs, compared to routine discharges home, reduced the positive association between depressive symptoms and 30-day hospital readmissions (OR = 0.95, p = 0.029) but did not prevent 30-day falls, 1-year falls, or 1-year mortality associated with depressive symptoms. Discussion: Depressive symptoms were associated with discharges to SNFs, but SNFs do not appear to address depressive symptoms to enhance functioning and survival.

Measuring More Than Exposure: Does Stress Appraisal Matter for Black-White Differences in Anxiety and Depressive Symptoms Among Older Adults?

BACKGROUND AND OBJECTIVES: Prior research and theory suggest that exposure to objectively stressful events contributes to mental health disparities. Yet, blacks report higher cumulative stress exposure than whites but lower levels of common psychiatric disorders. In order to understand why blacks bear disproportionate stress exposure but similar or better mental health relative to whites, we need to consider race differences in not only stress exposure, but also stress appraisal-how upsetting stress exposures are perceived to be. RESEARCH DESIGN AND METHODS: We examine whether race differences in the number of reported chronic stressors across 5 domains (health, financial, residential, relationship, and caregiving) and their appraised stressfulness explain black-white differences in anxiety and depressive symptoms. Data come from 6019 adults aged older than 52 from the 2006 Health and Retirement Study. RESULTS: Older blacks in this sample experience greater exposure to chronic stressors but appraise stressors as less upsetting relative to whites. In fully adjusted models, stress exposure is related to higher levels of anxiety and depressive symptoms, and perceiving stress as upsetting is associated with higher symptomology for whites and blacks. We also find that blacks report greater anxiety symptoms but fewer depressive symptoms with more stress exposure relative to whites. Stress appraisal partially explains race differences in the association between stress exposure and anxiety symptoms and fully explains race differences in the association between exposure and depressive symptoms. DISCUSSION AND IMPLICATIONS: The relationship between race, chronic stress exposure, and mental health is mediated by stress appraisal. Stress appraisal provides insight on important pathways contributing to black-white mental health disparities in older adulthood.

US life expectancy stalls due to cardiovascular disease, not drug deaths.

After decades of robust growth, the rise in US life expectancy stalled after 2010. Explanations for the stall have focused on rising drug-related deaths. Here we show that a stagnating decline in cardiovascular disease (CVD) mortality was the main culprit, outpacing and overshadowing the effects of all other causes of death. The CVD stagnation held back the increase of US life expectancy at age 25 y by 1.14 y in women and men, between 2010 and 2017. Rising drug-related deaths had a much smaller effect: 0.1 y in women and 0.4 y in men. Comparisons with other high-income countries reveal that the US CVD stagnation is unusually strong, contributing to a stark mortality divergence between the US and peer nations. Without the aid of CVD mortality declines, future US life expectancy gains must come from other causes-a monumental task given the enormity of earlier declines in CVD death rates. Reversal of the drug overdose epidemic will be beneficial, but insufficient for achieving pre-2010 pace of life expectancy growth.

Associations Between Diagnosis with Type 2 Diabetes and Changes in Physical Activity among Middle-Aged and Older Adults in the United States.

BACKGROUND AND OBJECTIVES: Physical activity (PA) is an effective strategy for diabetes self-management and is central to the diabetes regimen. Diagnostic events present an opportunity for health behavior change; however, many older adults with type 2 diabetes (T2D) do not engage in regular PA. The relationships between diagnosis events and subsequent changes in PA are not well understood. Drawing upon life-course theory, this is the first study to examine whether the diagnosis of T2D is followed by a change in PA, whether these changes are sustained, and the sociodemographic characteristics associated with these changes. RESEARCH DESIGN AND METHODS: We examined associations between T2D diagnosis and PA changes among 2,394 adults ages 51+ from the Health and Retirement Study (2004-2014). PA changes were measured using metabolic equivalents of task (METs) estimated values accounting for the vigor and frequency of self-reported PA. Using piecewise mixed models, we examined initial and sustained changes in METs over time and tested whether these changes were modified by race/ethnicity, educational level, gender, and age at diagnosis. RESULTS: Across participants, a significant postdiagnosis increase was observed in self-reported PA following the diagnostic event (ß: 0.54, 95% CI: 0.10, 0.97). The steepness of decline in PA participation over time did not change significantly following T2D diagnosis. Age at diagnosis and race/ethnicity significantly moderated these relationships: participants diagnosed at older ages were less likely to improve PA following diagnosis and non-Hispanic whites experienced relatively steeper rates of decline following diagnosis with T2D. DISCUSSION AND IMPLICATIONS: Modest diagnosis-related increases in PA were observed among participants overall. The usual rate of decline in PA appears unaffected by diagnosis overall. Age at diagnosis and race/ethnicity moderated these relationships. Key implications for future research and clinical practice are discussed.

Gender differences in relationships between sociodemographic factors and e-cigarette use with smoking cessation: 2014-15 current population survey tobacco use supplement.

BACKGROUND: There is conflicting evidence regarding whether men and women are equally likely to quit smoking. We assessed whether gender differences in smoking cessation varied between different sociodemographic groups and across e-cigarette use. METHODS: The 2014-15 cross-section of the Current Population Survey Tobacco Use Supplement was weighted to represent the US adult population of current/former smokers (N = 16 040). Log binomial models tested whether gender modified the relationships between race/ethnicity, education, income or e-cigarette use and 90-day smoking cessation in the past year. RESULTS: Gender was not associated with cessation in adjusted models (RR = 0.97, CI: 0.85, 1.11). There were no statistically significant interactions between gender and sociodemographic covariates. Current e-cigarette use was associated with higher cessation (RR = 1.53, CI: 1.30, 1.81), and the association varied by gender (Interaction P = 0.013). While male e-cigarette users had a 15% predicted cessation in the past year (CI: 12, 18%), female users had a 9% predicted cessation (95% CI: 7, 11%). Probability of cessation for female e-cigarette users was not different from non-users. CONCLUSIONS: These findings suggest that there are no gender differences in smoking cessation in the USA overall, or by sociodemographic groups. Current e-cigarette use is associated with higher likelihood of recent successful smoking cessation, particularly for men.

Changes in depressive symptoms over age among older Americans: Differences by gender, race/ethnicity, education, and birth cohort.

Despite concerns about recent trends in the health and functioning of older Americans, little is known about dynamics of depression among recent cohorts of U.S. older adults and how these dynamics differ across sociodemographic groups. This study examined sociodemographic differences in mid- and late-life depressive symptoms over age, as well as changes over time. Using nationally representative data from the Health and Retirement Study (1994-2014), we estimated mixed effects models to generate depressive symptoms over age by gender, race/ethnicity, education, and birth cohort in 33,280 adults ages 51-90 years. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression scale. Women compared to men, low compared to high education groups, and racial/ethnic minorities compared to whites exhibited higher depressive symptoms. The largest disparity resulted from education, with those without high school degrees exhibiting over two more predicted depressive symptoms in midlife compared to those with college degrees. Importantly, war babies and baby boomers (born 1942-1959) exhibited slightly higher depressive symptoms with more decreasing symptoms over age than their predecessors (born 1931-1941) at ages 51-65. We additionally observed an age-as-leveler pattern by gender, whereby females compared to males had higher depressive symptomology from ages 51-85, but not at ages 86-90. Our findings have implication for gauging the aging population's overall well-being, for public health policies aimed at reducing health disparities, and for anticipating demand on an array of health and social services.

Cognitive and affective factors linking mothers' perceived weight history to child feeding.

BACKGROUND/OBJECTIVES: To explore whether mothers' lifetime experiences with their own weight status and related cognitive and affective factors influence child feeding behavior. SUBJECTS/METHODS: Overweight mothers (N = 221) of 4-5 year olds recalled their weight at four time points, and were grouped into weight history trajectories: recently overweight, always overweight, and steady-gain-obese. Objective food choice behavior was assessed in a virtual reality buffet and subjective food restriction for the index child was assessed using a psychometric measure. RESULTS: Mothers' observed food choice was not associated with weight trajectory, but mothers who spent more time being overweight and who weighed more at present were more restrictive of their child's eating. Mothers' concern about child weight increased with more time spent being overweight. Concern for child weight and mothers' body guilt differentially mediated the relationships between weight trajectories and perceived feeding restriction. CONCLUSIONS: Considering mothers' lifetime weight experiences may suggest that parental influences on child feeding are amenable to intervention that would otherwise be obscured by static weight measures.

Media Exposure and Genetic Literacy Skills to Evaluate Angelina Jolie's Decision for Prophylactic Mastectomy.

PURPOSE: To examine public preparedness to evaluate and respond to Angelina Jolie's well-publicized decision to have a prophylactic mastectomy. METHODS: A consumer panel (n = 1,008) completed an online survey in November 2013, reporting exposure to Jolie's story, confidence applying genomic knowledge to evaluate her decision, and ability to interpret provided genetic risk information (genetic literacy skills). Linear and logistic regressions tested mediating/moderating models of these factors in association with opinions regarding mastectomies. RESULTS: Confidence with genomics was associated with increased genetic literacy skills and increased media exposure, with a significant interaction between the two. Confidence was also associated with favoring mastectomies for women with BRCA mutations, mediating the relationship with media exposure. Respondents were more likely to form opinions about mastectomies if they had high genetic literacy skills. CONCLUSION: These findings suggest that having higher genetic literacy skills may increase the public's ability to form opinions about clinical applications of genomic discovery. However, repeated media exposure to high-profile stories may artificially inflate confidence among those with low genetic literacy.

The Many Facets of Genetic Literacy: Assessing the Scalability of Multiple Measures for Broad Use in Survey Research.

OBJECTIVES: To determine how three dimensions of genetic literacy (familiarity, skills, and factual knowledge) fit the hierarchy of knowledge outlined in E.M. Rogers' Diffusion of Innovations to better conceptualize lay understandings of genomics. METHODS: A consumer panel representing the US adult population (N = 1016) completed an electronic survey in November 2013. Adjusting for education, we used correlations, principle components analysis, Mokken Scale tests, and linear regressions to assess how scores on the three genetic literacy sub-dimensions fit an ordered scale. RESULTS: The three scores significantly loaded onto one factor, even when adjusting for education. Analyses revealed moderate strength in scaling (0.416, p<0.001) and a difficulty ordering that matched Rogers' hierarchy (knowledge more difficult than skills, followed by familiarity). Skills scores partially mediated the association between familiarity and knowledge with a significant indirect effect (0.241, p<0.001). CONCLUSION: We established an ordering in genetic literacy sub-dimensions such that familiarity with terminology precedes skills using information, which in turn precedes factual knowledge. This ordering is important to contextualizing previous findings, guiding measurement in future research, and identifying gaps in the understanding of genomics relevant to the demands of differing applications.

Using a Historical Lens to Envision the Next Generation of Genomic Translation Research.

BACKGROUND: The past 20 years have witnessed successive and exponential advances in genomic discovery and technology, with a broad scientific imperative pushing for continual advancements. The most consistent critique of these advances is that they have vastly outpaced translation of new knowledge into improvements in public health and medicine. METHODS: We employ a historical and epistemological analysis to characterize how prevailing scientific meta-narratives have shaped the pace and priorities of research applying genomics to health promotion. We use four 'pivotal events' - the genetic characterization of Down syndrome, the launch of the Human Genome Research Project, the discovery of BRCA1, and the emergence of direct-to- consumer genetic testing - to illustrate how these scientific meta-narratives have inhibited genomic translation research. RESULTS: The notion that discovery should precede translation research has over-focused translation research on the latest genetic testing platform. The idea that genetic-related research has an exceptional potential for public harm has encouraged research on worst case scenarios. The perceived competition between genetics and social determinants of health has discouraged a unified research agenda to move genomic translation forward. CONCLUSION: We make a case for creating new scientific meta-narratives in which discovery and translation research agendas are envisioned as an interdependent enterprise.