Weathering the Pandemic: Dying Old at a Young Age from Pre-Existing Racist Conditions

Mainstream social epidemiology now acknowledges the contributions of interpersonal racism, racialized stress, and implicit bias to population health inequity. It also increasingly recognizes that current and historical racist policies place barriers in the way of healthy lifestyles by institutionalizing food deserts, housing decay, and austerity urbanism. Essential as these developments are, they only skim the surface of how insidiously structural racism establishes and reproduces population health inequity. I coined the term “weathering” to describe the effects of sustained cultural oppression upon the body. Weathering expands on the more conventional “social determinants of health” approach to understand the contextually fluctuating and historically structured and situated material, environmental and biopsychosocial stressors that wear-out the health of oppressed populations and shape their high effort coping strategies. I call this process “weathering” because that word is a contronym: Weathering can be a sign of deterioration and erosion as in “the rock was weathering;” and weathering can also be the opposite: A sign of strength and endurance as in “the family is weathering the recession.” For health and aging, it can be both

Behavioral Mechanisms in HIV Epidemiology and Prevention: Past, Present, and Future Roles

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72261/1/j.1728-4465.2009.00202.x.pd

Accumulating Disadvantage Over the Life Course: Evidence From a Longitudinal Study Investigating the Relationship Between Educational Advantage in Youth and Health in Middle Age

Recent studies suggest the importance of examining cumulative risk or advantage as potential predictors of health over the life course. Researchers investigating the cumulative health effects of education, however, have mainly conceptualized education in years or degrees, often disregarding educational quality and access to educational opportunities that may place individuals on divergent academic trajectories. We investigate whether educational advantages in youth are associated with an individual\u27s health trajectory. We develop a novel index of educational advantage and employ random-intercept modeling using data from the National Longitudinal Survey of Youth. We find a widening health disparity in adulthood between respondents with greater and those with fewer educational advantages in youth. Further, among respondents with few educational advantages, blacks experience a greater health burden as they age compared to whites and Hispanics. These results suggest that differential access to educational advantages during youth may contribute to persisting health disparities in adulthood

WP 2018-389

Recent research has found, in some groups of Americans, dramatic increases in deaths due to drug overdose and suicide and an overall stagnation of trends toward increased longevity. This study examines the link between mortality of older working age (45 to 64) adults and local economic downturns in the U.S. to evaluate the role of economic shifts in various causes of death and their related mortality trends. Specifically, we estimate regression models to test the hypotheses that the longevity effects of poor economic prospects are reflected through (1) increased suicide, drug overdose, and other “deaths of despair” and (2) other causes of death linked to exposure to economic and social stress such as heart and cerebrovascular disease. To avoid the problem of endogeneity of local economic conditions to mortality conditions, we measure the local economic shock of lost employment with predicted employment based on baseline industrial composition and national trends in employment by industry. We find evidence consistent with prior research that among non-Hispanic white adults, midlife mortality has increased since 1990, particularly among those with low educational attainment. We also find that “deaths of despair” are important contributors to that trend. However, we find that while distress in local, area economies does predict increased mortality for chronic disease, it predicts decreased mortality from suicides, opioids, and other substance abuse. This finding suggests caution in the application of the construct of despair in explaining recent mortality patterns.Social Security Adminstration, Award number RRC08098401-10, R-UM18-07https://deepblue.lib.umich.edu/bitstream/2027.42/148126/1/wp389.pdfDescription of wp389.pdf : Working pape

Associations between breast cancer subtype and neighborhood socioeconomic and racial composition among Black and White women

PURPOSE: Studies of Black-White differences in breast cancer subtype often emphasize potential ancestry-associated genetic or lifestyle risk factors without fully considering how the social or economic implications of race in the U.S. may influence risk. We assess whether neighborhood racial composition and/or socioeconomic status are associated with odds of triple-negative breast cancer (TNBC) diagnosis relative to the less-aggressive hormone receptor-positive/HER2-negative subtype (HR+ /HER-), and whether the observed relationships vary across women\u27s race and age groups. METHODS: We use multilevel generalized estimating equation models to evaluate odds of TNBC vs. HR+ /HER2- subtypes in a population-based cohort of 7291 Black and 74,208 White women diagnosed with breast cancer from 2006 to 2014. Final models include both neighborhood-level variables, adjusting for individual demographics and tumor characteristics. RESULTS: Relative to the HR+ /HER- subtype, we found modestly lower odds of TNBC subtype among White women with higher neighborhood median household income (statistically significant within the 45-64 age group, OR = 0.981 per $10,000 increase). Among Black women, both higher neighborhood income and higher percentages of Black neighborhood residents were associated with lower odds of TNBC relative to HR+ /HER2-. The largest reduction was observed among Black women diagnosed at age ≥ 65 (OR = 0.938 per$10,000 increase; OR = 0.942 per 10% increase in Black residents). CONCLUSION: The relationships between neighborhood composition, neighborhood socioeconomic status, and odds of TNBC differ by race and age. Racially patterned social factors warrant further exploration in breast cancer subtype disparities research

Are benefits conferred with greater socioeconomic position undermined by racial discrimination among African American men?

http://dx.doi.org/10.1016/j.jomh.2012.03.00

Damned if you do: culture, identity, privilege, and teenage childbearing in the United States

Why is the broad American public disapproving of urban African American teen mothers and unaware that the scientific evidence on the consequences of teen childbearing, per se, is equivocal? I focus on the links between culture, identity, and privilege. I argue that the broader society is selective in its attention to the actual life chances of urban African Americans and how these chances shape fertility-timing norms, in part, because this selective focus helps maintain the core values, competencies, and privileges of the dominant group. Delayed childbearing is an adaptive practice for European Americans and an intensely salient goal they have for their children. Yet early fertility-timing patterns may constitute adaptive practice for African American residents of high-poverty urban areas, in no small measure because they contend with structural constraints that shorten healthy life expectancy. European Americans put their cultural priorities into action ahead of the needs of African Americans and employ substantial resources to disseminate the social control message meant for their youth that teenage childbearing has disastrous consequences. Their ability to develop a more nuanced understanding of early childbearing is limited by their culturally mediated perceptions. Thus, cultural dominance can be perpetuated by well-meaning people consciously dedicated to children's well-being, social justice, and the public good. The entrenched cultural interdependence of and social inequality between European and African Americans leads African Americans to be highly visible targets of moral condemnation for their fertility behavior, and also sets up African Americans to pay a particularly high political, economic, psychosocial, and health price.Teenage pregnancy Culture Racial inequalities in health Urban Poverty Family USA