The intersection of school racial composition and student race/ethnicity on adolescent depressive and somatic symptoms

http://dx.doi.org/10.1016/j.socscimed.2011.03.03

The intersection of school racial composition and student race/ethnicity on adolescent depressive and somatic symptoms

Schools are one of the strongest socializing forces in the U.S. and wield considerable influence over individuals' social and economic trajectories. Our study investigates how school-level racial composition, measured by the percentage non-Hispanic white students in a school, affects depressive and somatic symptoms among a representative sample of U.S. adolescents, and whether the association differs by race/ethnicity. We analyzed Wave I data from the US National Longitudinal Study of Adolescent Health, resulting in a sample size of 18,419 students attending 132 junior and senior high schools in 1994/5. After controlling for individual and school characteristics, our multilevel analyses indicated that with increasing percentages of white students at their school, black students experienced more depressive symptoms and a higher risk of reporting high levels of somatic symptoms. After including students' perceptions of discrimination and school attachment, the interaction between black student race and school-level racial composition was no longer significant for either outcome. Our findings suggest that attending predominantly-minority schools may buffer black students from discrimination and increase their school attachment, which may reduce their risk of experiencing depressive and somatic symptoms.USA School segregation Mental health Discrimination School attachment School socio-economic status Adolescents Ethnicity

Financial Toxicity of Cancer Care: An Analysis of Financial Burden in Three Distinct Health Care Systems.

PurposeThe financial toxicity of cancer care is a source of significant distress for patients with cancer. The purpose of this study is to understand factors associated with financial toxicity in three distinct care systems.MethodsWe conducted a cross-sectional survey of patients in three care systems, Stanford Cancer Institute (SCI), VA Palo Alto Health Care System (VAPAHCS), and Santa Clara Valley Medical Center (SCVMC), from October 2017 to May 2019. We assessed demographic factors, employment status, and out-of-pocket costs (OOPCs) and administered the validated COmprehensive Score for financial Toxicity tool. We calculated descriptive statistics and conducted linear regression models to analyze factors associated with financial toxicity.ResultsFour hundred forty-four of 578 patients (77%) completed the entire COmprehensive Score for financial Toxicity tool and were included in the analysis. Most respondents at SCI were White, with annual household income (AHI) > $50,000 USD and Medicare insurance. At the VAPAHCS, most were White, with AHI ≤$50,000 USD and insured by the Veterans Administration. At SCVMC, most were Asian and/or Pacific Islander, with AHI ≤ $25,000 USD and Medicaid insurance. Low AHI (P < .0001), high OOPCs (P = .003), and employment changes as a result of cancer diagnosis (P < .0001) were associated with financial toxicity in the pooled analysis. There was variation in factors associated with financial toxicity by site, with employment changes significant at SCI, OOPCs at SCVMC, and no significant factors at the VAPAHCS.ConclusionLow AHI, high OOPCs, and employment changes contribute to financial toxicity; however, there are variations based on site of care. Future studies should tailor financial toxicity interventions within care delivery systems