The role of socioeconomic factors in Black-White health inequities across the life course: Point-in-time measures, long-term exposures, and differential health returns

Research links Black-White health disparities to racial differences in socioeconomic status (SES), but understanding of the role of SES in racial health gaps has been restricted by reliance on static measures of health and socioeconomic well-being that mask the dynamic quality of these processes and ignore the racialized nature of the SES-health connection. Utilizing twenty-three years of longitudinal data from the Panel Study of Income Dynamics (1984-2007), this study uses multilevel growth curve models to examine how multiple dimensions of socioeconomic well-being—including long-term economic history and differential returns to SES—contribute to the life course patterning of Black-White health disparities across two critical markers of well-being: body mass index (N=9,057) and self-rated health (N=11,329). Findings indicate that long-term SES exerts a significant influence on both body mass index and self-rated health, net of point-in-time measures, and that Black-White health gaps are smallest in models that adjust for both long-term and current SES. I also find that Blacks and Whites receive differential health returns to increases in SES, which suggests that other factors—such as neighborhood segregation and exposure racial discrimination—may restrict Blacks from converting increases in SES into health improvements in the same way as Whites. Together, these processes contribute to the life course patterning of Black-White health gaps and raise concerns about previous misestimation of the role of SES in racial health disparities

The physiological impacts of wealth shocks in late life: Evidence from the Great Recession

Given documented links between individual socioeconomic status (SES) and health, it is likely that—in addition to its impacts on individuals’ wallets and bank accounts—the Great Recession also took a toll on individuals’ disease and mortality risk. Exploiting a quasi-natural experiment design, this study utilizes nationally representative, longitudinal data from the National Social Life, Health, and Aging Project (NSHAP) (2005-2011) (N=930) and individual fixed effects models to examine how household-level wealth shocks experienced during the Great Recession relate to changes in biophysiological functioning in older adults. Results indicate that wealth shocks significantly predicted changes in physiological functioning, such that losses in net worth from the pre- to the post-Recession period were associated with increases in systolic blood pressure and C-reactive protein over the six year period. Further, while the association between wealth shocks and changes in blood pressure was unattenuated with the inclusion of other indicators of SES, psychosocial well-being, and health behaviors in analytic models, we document some evidence of mediation in the association between changes in wealth and changes in C-reactive protein, which suggests specificity in the social and biophysiological mechanisms relating wealth shocks and health at older ages. Linking macro-level conditions, meso-level household environments, and micro-level biological processes, this study provides new insights into the mechanisms through which economic inequality contributes to disease and mortality risk in late life

The Health Impacts of Eviction: Evidence from the National Longitudinal Study of Adolescent to Adult Health

Eviction represents an urgent social and economic issue in the United States, with nearly two million evictions occurring annually in the U.S. Still, the population health impacts of evictions, as well as the pathways linking eviction to health, are not well documented or understood, particularly among young adults. Using nationally-representative, longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (1994-2008) (n=9,029), the present study uses a combination of analytic methods—including prospective lagged dependent variable regression models, inverse probabilities of treatment weighting, longitudinal first difference models, causal mediation techniques—to comprehensively assess whether and how evictions relate to depressive risk and self-rated health across early adulthood, paying particular attention to the stress-related pathways linking eviction and health. Results provide robust evidence of positive longitudinal associations between eviction and depressive risk, in particular. In the prospective regression models, young adults who experienced recent eviction had more depressive symptoms and worse self-rated health than those who were not evicted, net a host of background characteristics. Using treatment weighting techniques, results showed that young adults who experienced eviction had more depressive symptoms than those who were not evicted (5.921 vs. 4.998 depressive symptoms, p=0.003). Perceived social stress mediated nearly 18 percent of the associations between eviction and the depressive symptoms (p\u3c0.001). In the first difference models, young people who experienced eviction between survey waves experienced greater increases in depressive symptoms over time compared to those who were not evicted, net of changes in other indicators of socioeconomic status and residential instability. Taken together, our results suggest that the recent surges in evictions in the U.S. serve as a potent threat to population health during the emerging adult period, with especially devastating consequences for low-income individuals and communities of color

Inequality “Under the Skin”: Stress and the Biodemography of Racial Health Disparities Across the Life Course

Black-White disparities in morbidity and mortality can be observed across the life course, from birth through late life. Given the persistence of racial health gaps across time and space, a wide body of literature seeks to better understand the social factors contributing to these disparities, and research suggests that racial differences in exposure to social stressors play a critical—yet largely underestimated—role in Black-White health gaps. Still, critical gaps in scientific understanding of how racial differences in exposure to stressors across the life course contribute to Black-White disparities in disease emergence and progression remain. Using two longitudinal, population-level data sets that collectively span from adolescence through late adulthood, this research examines how racial inequality patterns exposure to material conditions and psychosocial stressors to promote physiological and psychological dysregulation and ultimately affect health and disease risk. In particular, this study assesses how racial differences in exposure to stress related to criminal justice contacts, neighborhood conditions, and lifetime events and chronic strains affect Black-White inequities in pre-disease biomarkers of health and physiological function. This research thus improves scientific understanding of how racism patterns exposure to material conditions and psychosocial stressors to promote physiological and psychological dysregulation and ultimately affect health and disease risk on a population level.Doctor of Philosoph

The role of SES in the racial stratification of health across the life course

The racial patterning of socioeconomic status (SES) in the U.S. is a key determinant of racial health disparities, yet critical questions about the role of SES in producing racial health inequality remain. This study examines how various socioeconomic factors--including wealth, duration spent in economic advantage or deprivation, and differential returns to SES--contribute to racial health inequality across the life course. Findings show that, net of income and education, wealth and duration of exposure to economic advantage or deprivation are significant contributors to the Black-White health gap. I also find that Blacks receive fewer health returns to increases in education than Whites, which contributes to the divergence of the health gap with age. These findings suggest that failure to consider wealth, duration of exposure to economic conditions, and differential returns to SES in studies of racial health disparities can result in the residual confounding of race and SES.Master of Art

“Toxic” Schools? How School Exposures During Adolescence Influence Trajectories of Health Through Young Adulthood

© 2020 The Author(s) A large body of research identifies the critical role of early-life social contexts such as neighborhoods and households in shaping life course trajectories of health. Less is known about whether and how school characteristics affect individual health and contribute to population health inequality. However, recent scholarship argues that some school environments are so stressful due to high levels of violence, disorder, and poverty that they may be “toxic” to student health, but this hypothesis has not been tested using population data. Integrating insights from the life course perspective and stress process model, we use rich longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (n = 11,382), diverse markers of physiological functioning and psychological well-being, and multilevel regression models to examine whether and how school characteristics shape trajectories of physiological dysregulation and depressive risk from adolescence through early adulthood. Findings reveal that, across multiple measures of physiological functioning and psychological well-being, the social and structural characteristics of schools play an essential role in shaping health risk from adolescence through young adulthood—long after students left school. In particular, indicators of school-level violence and perceptions of safety and school social disconnectedness had especially strong associations with health risk in both the short- and long-term. School socioeconomic composition was also strongly associated with physiological dysregulation in young adulthood, net of individual and neighborhood socioeconomic exposures. Together, findings from this study suggest that school environments can serve as early-life stressors in the lives of young people that unequally shape health trajectories and contribute to broader patterns of health inequality

Early-Life Socioeconomic Status and Adult Physiological Functioning: A Life Course Examination of Biosocial Mechanisms

A growing literature has demonstrated a link between early-life socioeconomic conditions and adult health at a singular point in life. No research exists, however, that specifies the life course patterns of socioeconomic status (SES) in relation to the underlying biological processes that determine health. Using an innovative life course research design consisting of four nationally representative longitudinal datasets that collectively cover the human life span from early adolescence to old age (Add Health, MIDUS, NSHAP, and HRS), we address this scientific gap and assess how SES pathways from childhood into adulthood are associated with biophysiological outcomes in different adult life stages. For each dataset, we constructed standardized, composite measures of early-life SES and adult SES and harmonized biophysiological measurements of immune and metabolic functioning. We found that the relative importance of early-life and adult SES varied across young-, mid-, and late-adulthood, such that early-life SES sets a life course trajectory of socioeconomic well-being and operates through adult SES to influence health as adults age. We also documented evidence of the detrimental health effects of downward mobility and persistent socioeconomic disadvantage. These findings are the first to specify the life course patterns of SES that matter for underlying biophysiological functioning in different stages of adulthood. The study thus contributes new knowledge critical for improving population health by identifying the particular points in the life course in which interventions might be most effective in preventing disease and premature mortality

Social Relationships and Hypertension in Late Life: Evidence From a Nationally Representative Longitudinal Study of Older Adults

Social relationships are widely understood to be important for sustaining and improving health and longevity, but it remains unclear how different dimensions of social relationships operate through similar or distinct mechanisms to affect biophysiological markers of aging-related disease over time

Social relationships and physiological determinants of longevity across the human life span

Although much evidence has accrued in research over the past 20 years on the strong causal associations between social relationships and health and longevity, important gaps remain in our understanding of the mechanisms, timing, and duration of these associations. This study integrates social and biological disciplinary perspectives and research to examine how social relationships “get under the skin” to affect physiological well-being as individuals age. By combining data from and harmonizing measurement across four large nationally representative, population-based, contemporary surveys using an innovative longitudinal life course design, this study provides previously unidentified evidence on the biological and life course mechanisms linking social relationship patterns with health. As such, our findings advance explanations of the emergence and progression of diseases across the human life span

Early life patterns of criminal legal system involvement: Inequalities by race/ethnicity, gender, and parental education

Background: Contacts with the criminal legal system have consequences for a host of outcomes. Still, early life age patterns of system involvement remain to be better understood. Objective: We estimate cumulative risks of arrest, probation, and incarceration from childhood through early adulthood and assess disparities by race/ethnicity, gender, and parental education. Methods: Data come from the Transition to Adulthood Supplement of the Panel Study of Income Dynamics (n = 2,736). We use Kaplan-Meier curves and Cox regression models to estimate cumulative risks of arrest, probation, and incarceration across the early life course and document disparities by race/ethnicity, gender, and parental education, as well as at their intersections. Results: Criminal legal system involvement is common among recent cohorts, but Black and Latinx boys and young men face especially high risks. Among Black men whose highest-educated parent completed high school or less, an estimated six in ten had been arrested, four in ten had experienced probation, and four in ten had been incarcerated by age 26. Among Latinx men whose highest-educated parent completed high school or less, an estimated four in ten had been arrested and one in four had been incarcerated by age 26. Black women also experienced high risks, with an estimated one in four arrested by age 26. Contribution: We document early life patterns of criminal legal system involvement among young people who came of age during the expansion of proactive policing and mass incarceration in the United States, providing important context for understanding the role of the system in generating and exacerbating life course inequalities