Educational attainment and the clustering of health-related behavior among U.S. young adults

We documented health-related behavior clustering among US young adults and assessed the extent to which educational attainment was associated with the identified clusters. Using data from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we performed latent class analysis on 8 health-related behaviors (n = 14,338), documenting clustering of behavior separately by gender. Subsequently, we used multinomial logistic regression and estimated associations between educational attainment and the health-related behavior clusters. Twenty-eight percent of young women grouped into the most favorable health behavior cluster, while 22 percent grouped into a very high-risk cluster. A larger percentage of young men (40 percent) grouped into the highest risk cluster. Individuals with educational attainment at the college and advanced degree levels exhibited much lower risk of being in the unhealthy behavioral clusters than individuals with lower educational attainment, net of a range of confounders. Substantial fractions of US young adults, particularly those with less than college degrees, exhibit unhealthy behavior profiles. Efforts to improve health among young adults should focus particular attention on the clustering of poor health-related behavior, especially among individuals who have less than a college degree

Racial Disparities in Functional Limitations Among Hispanic Women in the United States

This paper assesses whether there are race differences in functional health among Hispanic women in the United States; ascertains whether the race differences in functional health vary by age; and examines the extent to which race differences in functional health are attributable to key dimensions of demographic, geographic, and socioeconomic heterogeneity. The analysis is based on 15 years of aggregated data from the National Health Interview Survey. Both U.S.- and foreign-born black and other race Hispanic women display a higher level of functional limitations than their white Hispanic counterparts. There is little evidence that such health differences widen with age. U.S.-born black Hispanic women, however, suffer from a high burden of functional limitations across the adult age range. This research speaks to the need for greater attention to racial differences in health among Hispanics, and particularly so within the U.S.-born segment of this rapidly aging population

Gender and Health Behavior Clustering among U.S. Young Adults

U.S. trends in population health suggest alarming disparities among young adults who are less healthy across most measureable domains than their counterparts in other high-income countries; these international comparisons are particularly troubling for women. To deepen our understanding of gender disparities in health and underlying behavioral contributions, we document gender-specific clusters of health behavior among U.S. young adults using nationally representative data from the National Longitudinal Study of Adolescent to Adult Health. We find high levels of poor health behavior, but especially among men; 40 percent of men clustered into a group characterized by unhealthy behavior (e.g., poor diet, no exercise, substance use), compared to only 22 percent of women. Additionally, women tend to age out of unhealthy behaviors in young adulthood more than men. Further, we uncover gender differences in the extent to which sociodemographic position and adolescent contexts inform health behavior clustering. For example, college education was more protective for men, whereas marital status was equally protective across gender. Parental drinking mattered for health behavior clustering among men, whereas peer drinking mattered for clustering among women. We discuss these results in the context of declining female advantage in U.S. health and changing young adult social and health contexts

Hispanic-White Differences in Lifespan Variability in the United States

This study is the first to investigate whether and, if so, why Hispanics and non-Hispanic whites in the United States differ in the variability of their lifespans. Although Hispanics enjoy higher life expectancy than whites, very little is known about how lifespan variability—and thus uncertainty about length of life—differs by race/ethnicity. We use 2010 U.S. National Vital Statistics System data to calculate lifespan variance at ages 10 and older for Hispanics and whites, and then decompose the Hispanic-white variance difference into cause-specific spread, allocation, and timing effects. In addition to their higher life expectancy relative to whites, Hispanics also exhibit 7 % lower lifespan variability, with a larger gap among women than men. Differences in cause-specific incidence (allocation effects) explain nearly two-thirds of Hispanics’ lower lifespan variability, mainly because of the higher mortality from suicide, accidental poisoning, and lung cancer among whites. Most of the remaining Hispanic-white variance difference is due to greater age dispersion (spread effects) in mortality from heart disease and residual causes among whites than Hispanics. Thus, the Hispanic paradox—that a socioeconomically disadvantaged population (Hispanics) enjoys a mortality advantage over a socioeconomically advantaged population (whites)—pertains to lifespan variability as well as to life expectancy. Efforts to reduce U.S. lifespan variability and simultaneously increase life expectancy, especially for whites, should target premature, young adult causes of death—in particular, suicide, accidental poisoning, and homicide. We conclude by discussing how the analysis of Hispanic-white differences in lifespan variability contributes to our understanding of the Hispanic paradox

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

Racial/Ethnic Differences in Early-Life Mortality in the United States

U.S. early life (ages 1–24) deaths are tragic, far too common, and largely preventable. Yet demographers have focused scant attention on U.S. early life mortality patterns, particularly as they vary across racial and ethnic groups. We employ the restricted-use 1999–2011 National Health Interview Survey-Linked Mortality Files and hazard models to examine racial/ethnic differences in early life mortality. Our results reveal that these disparities are large, strongly related to differences in parental socioeconomic status, and expressed through different causes of death. Compared to non-Hispanic whites, non-Hispanic blacks experience 60%, and Mexican Americans 32% higher risk of death over the follow-up period, with demographic controls. Our finding that Mexican Americans experience higher early life mortality risk than non-Hispanic whites differs from much of the literature on adult mortality. We also show that these racial/ethnic differences attenuate with controls for family structure and especially with measures of socioeconomic status. For example, higher mortality risk among Mexican-Americans relative to non-Hispanic whites is no longer significant once we control for mother’s education or family income. Our results strongly suggest that eliminating socioeconomic gaps across groups is the key to enhanced survival for children and adolescents in racial/ethnic minority groups

Fitting Age-Period-Cohort Models Using the Intrinsic Estimator: Assumptions and Misapplications

We thank Demography’s editorial office for the opportunity to respond to te Grotenhuis et al.’s commentary regarding the methods used and the results presented in our earlier paper (Masters et al. 2014). In this response, we briefly reply to three general themes raised in the commentary: (1) the presentation and discussion of APC results, (2) the fitting of full APC models to data for which a simpler model holds, and (3) the variation in the estimated age, period, and cohort coefficients produced by the intrinsic estimator (IE) (i.e., the “non-uniqueness property” of the IE, as referred to by Pelzer et al. (2015))

Historical Neighborhood Redlining

The source data used to construct this contextual file for the National Longitudinal Study of Adolescent to Adult Health (Add Health) come from Mapping Inequality: Redlining in New Deal America, compiled by Robert K. Nelson and the Digital Scholarship Lab at the University of Richmond. This file augments the current Add Health contextual data collection by providing information about whether a respondent’s place of residence falls inside or within varying proximities to historically redlined neighborhood boundaries at the time of their Wave I, III, IV, and V survey interviews. This contextual database allows researchers to identify potential long-term consequences of redlining for contemporary inequities in neighborhood environments, and individual health and socioeconomic attainment over the life course. Before analyzing these data, however, we urge users to review the following background section and cited references

Depressive Symptoms in The National Longitudinal Study of Adolescent to Adult Health (Add Health)

Depressive symptoms are common, affecting an estimated 18.5% of adults in the United States (US) in a recent two-week period (Villarroel and Terlizzi 2020). The prevalence of depressive symptoms rose sharply among US adolescents and young adults between 2012 and 2018 (Keyes et al. 2019) and tripled among adults ages 18 and over from 2019 to 2020 during the early stages of the COVID-19 pandemic (Ettman et al. 2020). The burden of depressive symptoms is also unequally distributed across the US population, such that some sociodemographic groups tend to experience higher depressive symptom levels than others. This data brief highlights the utility of using the National Longitudinal Study of Adolescent to Adult Health (Add Health) to study depressive symptoms among US adults

Mortality Attributable to Low Levels of Education in the United States

BackgroundEducational disparities in U.S. adult mortality are large and have widened across birth cohorts. We consider three policy relevant scenarios and estimate the mortality attributable to: (1) individuals having less than a high school degree rather than a high school degree, (2) individuals having some college rather than a baccalaureate degree, and (3) individuals having anything less than a baccalaureate degree rather than a baccalaureate degree, using educational disparities specific to the 1925, 1935, and 1945 cohorts.MethodsWe use the National Health Interview Survey data (1986–2004) linked to prospective mortality through 2006 (N=1,008,949), and discrete-time survival models, to estimate education- and cohort-specific mortality rates. We use those mortality rates and data on the 2010 U.S. population from the American Community Survey, to calculate annual attributable mortality estimates.ResultsIf adults aged 25–85 in the 2010 U.S. population experienced the educational disparities in mortality observed in the 1945 cohort, 145,243 deaths could be attributed to individuals having less than a high school degree rather than a high school degree, 110,068 deaths could be attributed to individuals having some college rather than a baccalaureate degree, and 554,525 deaths could be attributed to individuals having anything less than a baccalaureate degree rather than a baccalaureate degree. Widening educational disparities between the 1925 and 1945 cohorts result in a doubling of attributable mortality. Mortality attributable to having less than a high school degree is proportionally similar among women and men and among non-Hispanic blacks and whites, and is greater for cardiovascular disease than for cancer.ConclusionsMortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers. Existing research suggests that a substantial part of the association between education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality