"Unhealthy" Returns to Education: Variation in BMI-associated Premature Adult Mortality by Educational Attainment

While obesity continues to be a significant health issue, the relationship between body weight and mortality risk remains unclear. Research notes the strong association between obesity and higher mortality risk, along with the “protective” effect of higher weight for some groups. Few studies have examined this relationship when stratified by socioeconomic status, especially when considering premature mortality among working-aged adults. Using recent National Health Interview Survey data, this study examines variation in BMI-associated premature mortality risk across different levels of education. Results indicate overweight and class I obesity are associated with lowest mortality risk among the lower-educated. Conversely obesity is associated with increased mortality risk for individuals with a college education or greater, while overweight is not associated with reduced risk. Thus, obesity may pose a greater relative health risk in more advantaged groups, such as the highly educated, while other socio-behavioral factors account for premature mortality among lower-educated individuals.Master of Art

A Growing Risk: Clinical, Epidemiologic, and Subjective Ambiguity in the Relationship between Weight and Health

This dissertation examines the complex and often uncertain relationship between body weight and health in a highly weight-conscious society like the United States, using a mixed methods approach to study three key domains in which this ambiguity is evident. The first chapter draws on interviews with clinicians to examine the tension between medical definitions of healthy weight used by practitioners, the metrics of success they seek to promote among patients, and the broader messaging about weight and health in the culture at-large. Notably, practitioners often avoid “diagnosing” childhood obesity and poor health in favor of emphasizing a more optimistic “prognosis” emphasizing children’s and families’ success in developing healthy beliefs and behaviors that engender long-term success. The second chapter questions the assumption of homogeneously poor health among adults with obesity by examining the clustering of body size and other measures of health in a large nationally-representative data set. Medical research often frames “healthy” and “unhealthy” obesity as a function of random biological differences in the population; conversely, my work shows that these phenotypes are socially-patterned on the basis of individuals’ socioeconomic status, helping to explain group differences in mortality. Finally, the third chapter examines the consequences of individuals’ perceptions of their weight over the life course. Social and cultural stereotypes about individuals on the basis of their weight suggest that negative perceptions of one’s weight can be psychosocially damaging, leading to many of the harmful outcomes that we associate with body weight. This study demonstrates that objective and subjective weight status influence each other over time, such that both impact health in adulthood. Critically, these analyses underscore the consequences of weight-related stigma as source of poor health that is attributable to social norms about what constitutes a “healthy” and “normal” body. In sum, this dissertation advances a more comprehensive approach to the study of and messaging about body weight and health, inclusive of a broader and more nuanced set of physiological and psychosocial explanations.Doctor of Philosoph

The Persistent Southern Disadvantage in Us Early Life Mortality, 1965‒2014

Background: Recent studies of US adult mortality demonstrate a growing disadvantage among southern states. Few studies have examined long-term trends and geographic patterns in US early life (ages 1 to 24) mortality, ages at which key risk factors and causes of death are quite different than among adults. Objective: This article examines trends and variations in early life mortality rates across US states and census divisions. We assess whether those variations have changed over a 50-year time period and which causes of death contribute to contemporary geographic disparities. Methods: We calculate all-cause and cause-specific death rates using death certificate data from the Multiple Cause of Death files, combining public-use files from 1965‒2004 and restricted data with state geographic identifiers from 2005‒2014. State population (denominator) data come from US decennial censuses or intercensal estimates. Results: Results demonstrate a persistent mortality disadvantage for young people (ages 1 to 24) living in southern states over the last 50 years, particularly those located in the East South Central and West South Central divisions. Motor vehicle accidents and homicide by firearm account for most of the contemporary southern disadvantage in US early life mortality. Contribution: Our results illustrate that US children and youth living in the southern United States have long suffered from higher levels of mortality than children and youth living in other parts of the country. Our findings also suggest the contemporary southern disadvantage in US early life mortality could potentially be reduced with state-level policies designed to prevent deaths involving motor vehicles and firearms

Contextual Despair

This document provides a summary of contextual variables at the tract, county, and state level that may be relevant to operationalizing different dimensions of “despair” in Add Health respondents’ environment, per the “deaths of despair” hypothesis advanced by Case and Deaton (2015; 2020)

“Outside the Skin”: The Persistence of Black–White Disparities in U.S. Early-Life Mortality

Research on Black&ndash;White disparities in mortality emphasizes the cumulative pathways through which racism gets &ldquo;under the skin&rdquo; to affect health. Yet this framing is less applicable in early life, when death is primarily attributable to external causes rather than cumulative, biological processes. We use mortality data from the National Vital Statistics System Multiple Cause of Death files and population counts from the Surveillance, Epidemiology, and End Result Program to analyze 705,801 deaths among Black and White males and females, ages 15&ndash;24. We estimate age-standardized death rates and single-decrement life tables to show how all-cause and cause-specific mortality changed from 1990 to 2016 by race and sex. Despite overall declines in early-life mortality, Black&ndash;White disparities remain unchanged across several causes&mdash;especially homicide, for which mortality is nearly 20 times as high among Black as among White males. Suicide and drug-related deaths are higher among White youth during this period, yet their impact on life expectancy at birth is less than half that of homicide among Black youth. Critically, early-life disparities are driven by preventable causes of death whose impact occurs &ldquo;outside the skin,&rdquo; reflecting racial differences in social exposures and experiences that prove harmful for both Black and White adolescents and young adults. &nbsp;</p

Defining despair: Assessing the multidimensionality of despair and its association with suicidality and substance use in early to middle adulthood

Despite considerable scientific interest in documenting growing despair among U.S. adults, far less attention has been paid to defining despair and identifying appropriate measures. Emerging perspectives from social science and psychiatry outline a comprehensive, multidimensional view of despair, inclusive of individuals’ cognitive, emotional, biological and somatic, and behavioral circumstances. The current study assesses the structure and plausibility of this framework based on longitudinal data spanning early to middle adulthood. We identified 40 measures of different dimensions of despair in Wave IV (2008–2009) of the National Longitudinal Study of Adult to Adolescent Health (n = 9149). We used structural equation modeling to evaluate hypothesized relationships among observed and latent variables; we then regressed Wave V (2016–2018) suicidality, heavy drinking, marijuana use, prescription drug misuse, and illicit drug use on latent despair. Our analyses find that models for separate dimensions of despair and overall despair demonstrated excellent fit. Overall despair was a significant predictor of Wave V outcomes, especially suicidality, accounting for 20% of its variation, as compared to 1%–7% of the variation in substance use. Suicidality was consistently associated with all domains of despair; behavioral despair explained the most variation in substance use. Given these results we contend that, lacking direct measures, latent despair can be modeled using available survey items; however, some items are likely better indicators of latent dimensions of despair than others. Moreover, the association between despair and key health behaviors varies considerably, challenging its status as a mechanism simultaneously underlying increased substance use and suicide mortality in the United States. Critically, further validation of measures in other surveys can improve the operationalization of despair and its associated conceptual and theoretical frameworks, thus advancing our understanding of this concept