Health Disparities
The elimination of health disparities by race/ethnicity and socioeconomic status is a key public health priority in the United States. Health disparities indicate the fault lines of inequalities in well-being in a population. In a society that is striving for both overall excellence as well as excellence health within all subgroups, disparities symbolize systematic, unequal access to some of society's most important resources, including the length of life itself. In addition, for those subgroups with less favorable health and higher mortality levels compared to the most advantaged subgroups, there is a substantial amount of human suffering, increased health care costs, and loss of economic productivity that could potentially be alleviated if health disparities did not exist. Large numbers of children, youth, and adult family members in the U.S. population face substantial challenges to healthy development from poverty, family instability, and disadvantages associated with minority status. PRC researchers are addressing important scientific questions about the social conditions and behaviors that promote or interfere with the health and well-being of children and families. This work is guided by a life course perspective that integrates demographic and population constructs with individual and family-level processes and transitions across the lifespan. PRC researchers collectively investigate all portions of the life course - from conception, pregnancy and infancy, to childhood and adolescences, and throughout adulthood. Throughout this work, PRC researchers emphasize knowledge that informs policy, prevention, and optimal points of intervention, and they are nationally renowned for their pioneering research on race/ethnic and socioeconomic disparities in health.
Area Projects
Conference Series on Aging in the Americas: United States and Mexico
Principal Investigator: Jacqueline Angel
Funded by: National Institute on Aging
The proposed new installments of the conference series on aging in the Americas (2012-2014) will focus on the state of readiness for addressing the needs of Latino elders and for sustaining their health and well-being. The most poignant example is the Mexico-U.S. contrast as these societies are contending with multiple demands for public use of scarce resources and have overlapping, interdependent populations and family networks transcending both nations. Thirty papers and six keynote speakers from sociology, psychology, social policy, medicine, economics, gerontology, demography, epidemiology, and community health will 1) discuss the impact of changing demographics on community capacity for successful aging, including health, housing, and food security; 2) create a strategic framework for future transnational comparative research on Hispanics in the U.S. and Mexico, including issue identification and the available data resources for advancing a high quality research menu on this fundamental issue; and 3) develop a set of goals for advancing the healthy aging in the Mexican-origin population from a bi-national perspective. Collectively, the research will provide new knowledge on the health consequences of emerging trends in the Americas for Hispanic communities and will inform new strategic initiatives to adequately respond to the accelerating demands of aging populations.
The Risk of Long-Term Care in Older Mexican-American Families
Principal Investigator: Jacqueline Angel
Additional Investigator: Ronald Angel
Funded by: National Institute on Minority Health and Health Disparities
Older people of Mexican origin make up one of the fastest -growing segments of the U.S. population, and their numbers are projected to increase sevenfold by 2050. This demographic explosion will place serious demands on the long-term care system, from family caregivers to federally sponsored sources of care. Mexican Americans suffer disproportionately from disabling conditions like diabetes that increase their risk of care in a nursing home or assisted-living facility. The relationship between functional decline and subsequent institutionalization for this population, however, may be largely influenced by a combination of factors, including economic resources and family and social support network. These factors may, in turn, vary by nativity, age at migration, and acculturation. To date, few studies have tested predictive models on how immigration-related factors, economic resources, and family support converge to determine care and living arrangements (i.e., living alone, living with spouse or family, or institutionalization) in elderly Mexican-origin individuals with declining functional status. The overall goal of this study is to clarify the most important factors associated with changes in the care and living arrangements of elderly Mexican Americans. We will evaluate a new empirical model to determine how immigration factors (e.g., nativity, age at migration, acculturation) and family resources (e.g., financial security, family and social support network) moderate how changes in functional status induce changes in care and living arrangements among older Mexican Americans in the United States. The specific aims are to: (1) examine the physical and cognitive functioning trajectories of elderly Mexican Americans between 1993 and 2008, by immigration factors; (2) assess how declines in functional status of elderly Mexican Americans relate to changes in care and living arrangements, by immigration factors; and (3) estimate the joint effect of family resources and immigration factors on use of nursing homes and assisted- living facilities by elderly Mexican Americans. We will use standard demographic and epidemiological techniques to analyze 3,952 individuals included in the Hispanic Established Populations for Epidemiologic Study of the Elderly (H-EPESE), the largest and most representative survey on the longitudinal health of older Mexican Americans. The results will identify key predictors of Mexican Americans' care and living arrangements, including the use of nursing homes and assisted-living facilities, providing important insights into social processes that will affect all aging families in the future. The study will also inform policy makers and best practice models in reducing disparities in unmet long-term care service needs.
Longitudinal Study of Mexican American Elderly Health
Principal Investigator: Ronald Angel
Additional Investigators: Kyriakos Markides, parent project PI
Jacqueline Angel, Co-Investigator, UT-Austin subcontract
Funded by: National Institute on Aging
This project will conduct two in-person follow-ups of the Hispanic EPESE (Established Population for the Epidemiological Study of Elderly) during 2009-2010 and 2011-2012. The study's baseline was conducted during 1993-1994 when a representative sample of 3,050 Mexican Americans age 65 and over residing in the five Southwestern states - Texas, New Mexico, Colorado, Arizona, and California - were interviewed and followed up four times. By 2004-2005 (Wave 5) 1,167 of the original subjects now aged 75 and over were re-interviewed. An additional representative sample of 902 Mexican Americans also aged 75 and over was added at Wave 5 giving us a combined sample of 2069 subjects aged 75 and over. Of these, 1542 were re-interviewed in 2007 (data still being processed), approximately 2 1/2 years later. The study thus far has generated over 170 publications and has provided valuable information related to the health and health care needs of older Mexican Americans. Wave 7 is proposed to take place in 2009-2010 and we estimate interviewing slightly over 1,000 surviving subjects aged 80 and over. We also propose to interview a "focal relative", most likely a child, who will supply information on the subjects' health, family, and financial situation. Both will be followed up two years later in 2011-2012. We expect that we will re-interview 700 subjects aged 82 and over and 800 of the focal relatives. Family members of deceased subjects will provide information on circumstances surrounding the subjects' death, which we have done over the years by using a proxy death questionnaire. Our first and new aim will be accomplished primarily by interviewing the focal relatives who will provide assessments of the older subjects' financial, family, and health situation. We will assess the nature and extent of any caregiving arrangements in very old Mexican Americans and the physical, psychological, and financial burdens of advanced age on the extended family. Given the advanced age of the sample, we expect to have sufficient numbers of subjects entering nursing homes and assisted living facilities to learn about factors leading to institutionalization. Although the rate of institutionalization among Mexican Americans is lower than that in the general population, our data thus far have suggested that it may be rising. We will have the opportunity to assess the influence of psychosocial and medical factors leading to institutionalization. We continue to assess trajectories of change in physical function, depressive symptomology, and cognitive function. We also propose to do a more extensive assessment of cognitive function including assessments made by the focal relatives. As we have done in the past, we plan to rapidly archive the data and to encourage others to use them. The Mexican American population is experiencing rapid rates of aging, and very little is known about the health, health care needs, and financial situation of the very old. Our findings thus far suggest that this is a population characterized by rising life expectancy which is accompanied by increased disease burden and increasing disabilityrates.
Social Demographics, Marginalization, and Adolescent Substance Use
Principal Investigator: Aprile D. Benner
Funded by: National Institute on Drug Abuse
Substance use during adolescence is an oft-studied phenomenon, but this research generally fails to take an ecological perspective on etiology. Schools are a primary context of socialization during adolescence, and understanding how school composition matters for substance use is critical for prevention efforts. Promoting school diversity has been a major legislative goal, but the unintended public health consequences of such policies are often ignored-diversity has empirically established academic benefits, yet it is not without its challenges, particularly regarding the socioemotional well-being of children and adolescents whose lack of demographic "fit" with their schools puts them at risk for social marginalization. Whether this demographic misfit (i.e., having few same-race/ethnic or same-socioeconomic peers in school) is risky for substance use has yet to be explored, although both theory and empirical evidence suggests that it might. The general goal of this project, therefore, is to examine whether, why, and when students who do not have a critical mass of same-race/ethnicity peers or peers of similar SES in school are more likely to drink and use drugs. Here, I use data from Add Health to explore three specific areas of inquiry. First, I will identify adolescents who are at the numeric margins of their schools both racially/ethnically and socioeconomically and compare their substance use to that of adolescents who have greater representation of same-demographic peers. Such research will highlight the potential unintended health risks of major academically-focused school reforms. Second, I will test two mechanisms by which marginalization might influence substance use: a) whether marginalization initiates feelings of misfit that, in turn, contribute to adolescents' substance use and b) whether the link between marginalization and substance use is stronger for students in schools and peer groups in which substance use is more normative. Third, the project will explore the extent to which the marginalization threshold (defined as 15% or more same-demographic peers) effectively captures the critical mass necessary for protection against substance use and lack of fit. Although the National Academy of Education recommends the 15% same-demographic peer threshold to protect against the harmful effects of marginalization, their report acknowledges that this estimate needs empirical validation. As a departure from previous, small-scale studies that explore the critical mass question, this project uses a large, nationally representative sample to empirically identify the critical mass needed to protect against social marginalization. Early substance use and abuse exert pernicious effects across the life course, and this project has the potential to expand our understanding of the implications of school composition for such risky health behaviors. By elucidating the mechanisms by which marginalization affects substance use, the project will highlight critical points of intervention, and by identifying the contextual antecedents of early substance use, the project will inform educational policy efforts that seek to better promote the full academic benefits of diversity in America's public schools.
Race/Ethnicity, Poverty, and the Connection between Child Health and Early Education
Principal Investigator: Robert L. Crosnoe
Additional Investigators: Shannon E. Cavanagh, Cynthia Osborne, Co-Investigator
Funded by: Eunice Kennedy Shriver National Institute of Child Health and Human Development
This project investigates the degree to which higher rates of health problems among race/ethnic minority children of all economic strata and among poor children from all race/ethnic populations prior to the start of elementary school put them at an academic disadvantage once elementary school has begun. Because health is a policy amenable developmental factor and the transition to elementary school is a critical intervention point in the educational career, such research provides leverage in attempts to address the persistent, overlapping race/ethnic and economic gaps in educational attainment in the early life course that forecast increasing inequalities in social mobility, morbidity, and mortality in adulthood. Drawing on a classic theoretical perspective that targets the development processes surrounding the transition into elementary school as fundamental to demographic disparities in educational attainment, this project puts forward and tests a conceptual model positing that the poorer physical and mental health of African-American and Latino/a children (controlling for economic status) and of economically disadvantaged children (controlling for race/ethnicity) in the pre-school years contribute to their lower rates of academic achievement in school. Importantly, this project will also explore the mechanisms underlying the academic risks of early health problems and identify aspects of family organization, pre-school programs, elementary school classrooms, and home-school partnerships that protect against these academic risks in general and in traditionally disadvantaged populations in particular. A team of population scientists working with senior consultants from medicine, developmental psychology, and social work will conduct this research. Specifically, this team will apply multi-level, growth curve, and propensity score techniques to two NIH-funded data sets the Fragile Families and Child Well-Being Study, which oversamples the disadvantaged side of the socioeconomic spectrum of American families, and the NICHD Study of Early Child Care and Youth Development, which oversamples the more advantaged side and then supplement this quantitative investigation with analysis of qualitative data to be collected from teachers and parents in a low-income, racially diverse elementary school. This interdisciplinary, theoretically grounded, mixed-methods investigation is specifically designed to elucidate the role of child health in the reproduction of overlapping systems of race/ethnic and economic stratification in ways that directly inform social policy.This project delves into a timely and significant public health issue: the contribution of the connection between health problems and academic struggles in early childhood to the race/ethnic and economic stratification of American society. The main goals are to determine a means by which demographic inequalities are transmitted across generations in ways that affect population rates of morbidity and mortality and then to identify potential policy-amenable remedies to this process.
Education and Alcohol Use in Adolescence and Young Adulthood
Principal Investigator: Robert Crosnoe
Additional Investigators: Chandra Muller and Paige Harden
Funded by: National Institute of Alcohol Abuse and Alcoholism
Drinking among high school and college students has long been a major public health concern in the U.S. As a key dimension of the connection between education and health, which has fascinated social and behavioral scientists for years, this link between secondary/postsecondary education and alcohol use is theoretically important. Focusing as it does on institutional settings that historically have been viewed as amenable to policy intervention, this link also points to ways that that such theoretical activity can be applied. Although the potential impact of educational experiences on youth drinking has been studied frequently, it is not well-understood in many ways that have implications for informing intervention. Following the "developmental" spirit of the R21 mechanism, therefore, this project draws on extant data to look into insufficiently known aspects of the education-drinking link and, in the process, support future primary data collections that focus on the most important aspects of the education-drinking link while addressing current data limitations. First, the specific dimensions of high school academic statuses and settings that matter to adolescent drinking, as well as the mechanisms underlying these associations, need to be better assessed and identified. This project draws on a unique data set-the integration of the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative study of health behavior in the early life course, and the Adolescent Health and Academic Achievement study (AHAA), which adds rich school transcript and textbook data to Add Health. This integrated data set allows the study of drinking to be informed by important innovations in educational theory and measurement, including more accurate renderings of: (a) adolescents' positions in the academic hierarchies of their schools, (b) the characteristics of their fellow students that they take classes with throughout school, and (c) the cognitive skills (e.g., critical analysis) that they develop through coursework and can draw on in health decision-making. Second, the extent to which the education-drinking link varies across stages of the life course will be considered by drawing on postsecondary AHAA data, the hypothesis being that the importance of the academic and social settings of colleges to the drinking of young adults will depend on their academic and social histories as adolescents in high school. Third, drawing on the genetic samples and DNA data of Add Health, this project will assess the degree to which both latent and specific genetic influences are confounded with the education-drinking link and whether they condition/trigger the effects of educational experiences on drinking in adolescence and young adulthood. The investigatory team includes sociologists and clinical/developmental psychologists who have experience in research on drinking, education, or both, including working with Add Health/AHAA and using advanced statistical techniques and genetically informed designs. The goal of this R21 is to explore fresh approaches to old questions about the education-drinking link in a cost-effective strategy that allows future, larger-scale data collections to be more effectively designed.
Preschool, Home, and School Contexts as Determinants of the Impacts of Head Start
Principal Investigator: Elizabeth Gershoff
Additional Investigator: Aletha Huston
Funded by: Eunice Kennedy Shriver National Institute of Child Health and Human Development
Head Start is the largest federal program providing an enriched early childhood education for children from low income families. A substantial body of non-experimental and quasi-experimental research has linked Head Start participation with (often modest) gains in children's developmental outcomes. Yet research to date has failed to examine how variability across Head Start centers is associated with variability in children's developmental outcomes, and how the quality of home and school environments experienced after Head Start might sustain, or curtail, the impacts of Head Start over time. To address this knowledge gap, the proposed project goes beyond questions of simple impact to consider the conditions and contexts which make Head Start more or less effective. Specifically, we will examine the extent to which the structure and quality of Head Start centers, parenting behavior and the home environment, and the structure and quality of elementary schools might mediate or moderate program impacts over time. Our interdisciplinary team (from the fields of human development, education, economics, and social work) will utilize two large, national Head Start studies--one of which used an experimental design--to address the following aims:
Aim 1: To identify to what extent, and by what processes, aspects of Head Start quality promote children's cognitive development, social-emotional skills, and physical health;
Aim 2: To determine the role of parents in creating and sustaining positive long-term impacts of Head Start on children's cognitive development, social-emotional skills, and physical health; and
Aim 3: To examine the extent to which subsequent school experiences moderate the persistence of Head Start effects on children's cognitive development, social-emotional skills, and physical health.
The project involves secondary data analysis of two large, federally sponsored data-sets, namely the Head Start Family and Child Experiences Survey, 1997 Cohort (FACES-97), and the Head Start Impact Study (HSIS). Each study included a nationally representative sample of 3- and 4-year-old low income children attending Head Start, along with one control group of children on waiting lists for Head Start in the HSIS. Research questions will be addressed using a combination of multiple regression, piecewise regression, latent class growth analysis, and multiple group analysis. Of particular interest will be interactions between treatment condition in the HSIS and center quality in the preschool year and school quality in the elementary school years.
Genetic Influences on Adolescent Decision-Making and Alcohol Use
Principal Investigator: Kathryn Paige Harden
Additional Investigator: Elliot Tucker-Drob
Funded by: National Institutes of Health
Alcohol use in adolescence is a leading contributor to accidental injuries, mental health problems, and mortality. In addition, adolescent drinking is commonly co-morbid with other risky behaviors, including smoking, illicit drug use, and delinquency. Despite concerted efforts at prevention, drinking and other risky behaviors are still widely prevalent in adolescence. Emerging research in neuroscience has suggested a novel biological mechanism for understanding developmental differences in risk-taking. Recent evidence suggests sub-cortical brain regions, which underlie automatic responses to emotions and rewards ("hot" influences on decision making), mature more quickly than cortical brain regions, which underlie planning and inhibition ("cold" deliberative influences on decision-making) and mature slowly through the mid-20s. Consistent with this model of adolescent brain development, our previous research found that performance on behavioral measures of cognitive control improves from early adolescence through early adulthood, whereas behavioral measures of reward sensitivity show a U-shaped pattern of development, with the highest reward sensitivity seen in middle adolescence. Thus middle adolescence (ages 15-16) is a particularly vulnerable period: When faced with a emotionally charged, highly novel, potentially pleasurable situation - like the offer of a drink - responding in the "hot" affective system is likely to overwhelm an adolescent's "cold" deliberative control. This research will extend our understanding of how adolescent decision-making influences alcohol use and other risky behaviors using a behavioral genetics design. The project focuses on two influences on adolescent decision-making, which will be measured using a previously validated battery of survey measures and objective cognitive tests: (1) reward sensitivity ("hot" responses to positive, rewarding, or novel stimuli); and (2) cognitive control ("cold" responses that require planning and inhibition). The project will use a novel, ethnically-diverse, population-based sample of 200 adolescent twin pairs, ages 15-16 (the age group in which the disjunction between reward sensitivity and cognitive control has been found to be the highest). Alcohol use, illicit drug use, delinquency, and fighting will be measured using twin self-report, parent report and official school record data on disciplinary infractions. This multi-method approach will address the following specific questions: (1) Do individual differences in cognitive control and reward sensitivity predict individual propensities for alcohol use and other risk-taking behaviors? (2) Are cognitive control and reward sensitivity endophenotypes for genetic influence on alcohol use and other risk-taking behaviors? and (3) How do family environments moderate the impact of high reward sensitivity on risk-taking behaviors? Data will be analyzed using sophisticated quantitative methods, including analyses of gene-environment interaction (GxE). The proposed research will thus integrate neuroscientific theories of adolescent brain development with behavioral genetic research methods, in order to identify novel specific endophenotypes for adolescent risk-taking.
Emerging Educational Inequalities in Health: New Health Events and Social Relationships
Principal Investigator: Elaine Hernandez
Faculty Sponsor: Robert Hummer
Funded by: Eunice Kennedy Shriver National Institute of Child Health and Human Development
Educational inequalities in morbidity and mortality are wide and growing, in spite of goals to eliminate them. People with more education are better positioned to avoid deleterious health effects when they are given new health information. Over time, as people act upon novel information differentially, educational inequalities in health outcomes emerge. Although research has been devoted to observing trends in education and health, less is known about the process by which they are produced. An emerging literature has attempted to understand how novel health information and technological advances influence people to behave differently depending on their socioeconomic status. Given the dearth of data on individual health knowledge levels, though, most often research is limited to observing changes in behavior after recent advances in biomedical research or exogenous shocks of health information. How can we understand the process by which educational inequalities in health emerge at the individual-level? The overall objective of this research is to understand how educational inequalities in health are produced among individuals, using a new approach: It focuses on people's health behaviors after they learn that they are pregnant or diagnosed with a chronic illness for the first time. Early decisions about health behaviors during these periods may serve to stratify later health behaviors among people of varying educational backgrounds. To understand how people behave differently after a new health event, this research proposes an innovative approach by focusing on the role of social relationships. It anticipates that these relationships provide people with new health information and influence their decisions about health behaviors. This conjecture builds upon a bedrock of sociological and public health research, which emphasizes the importance of social ties for both health and medical decision-making, as well as more recent research, which indicates that individuals' social ties influence their health behaviors. To assess the influence of social relationships on the formation of educational inequalities in health among people experiencing new health events, this research will take four approaches, and use data from nationally-representative surveys and qualitative interviews including the following: 1988 U.S. National Maternal and Infant Health Survey and the 1991 Longitudinal Follow-up; the Health and Retirement Study; the National Longitudinal Study of Adolescent Health; and the Relationships and Health Habits study. First, it will examine whether there are educational differences in nulliparous women's prenatal behaviors that are replicated during subsequent pregnancies. Second, it will focus on education differences in early health decisions among people recently diagnosed with an illness. Third, it will test whether social network processes of social learning and social influence differ by education and influence health behavior. Finally, for each set of analysis, it describes how the processes differ by race, ethnicity and gender. In sum, this research is significant because it aims to understand the origins of educational inequalities in health at an individual-level. It takes an innovative approach by merging this with demographic models of the diffusion of health information across social networks to understand how network processes influence health behaviors differently by education-level.
MacArthur Foundation Network on and Aging Society: Race/Ethnicity, Immigration, and Health in an Aging Society
Principal Investigator: Robert Hummer
Funded by: Columbia University
The overall goal of this research program is to analyze the health and mortality patterns of the immigrant and minority populations in the United States, with comparisons to the non-Hispanic white majority and with particular attention given to the underlying patterns of aging within all of the population subgroups to be analyzed. To best accomplish this overall goal, we will move beyond the traditional and exclusive focus on older age groups to examine the health and mortality patterns of prime-aged adults as well (i.e., individuals in those cohorts who will become the next group of U.S. elders). This will allow us to better anticipate the health and mortality patterns that will characterize the growing immigrant and minority populations as they enter old age between now and 2050. We aim to do so by exploiting the largest and most current nationally representative data sets at our disposal (e.g., the National Health Interview Survey, the National Longitudinal Mortality Study, the Health and Retirement Study, U.S. Vital Statistics data).
A Social Demography of Racial Health Disparities
Principal Investigator: Robert Hummer
Additional Investigators: Brian Finch, San Diego State University, parent project PI, UT-Austin subcontract
Funded by: National Center on Minority Health and Health Disparities
Health disparities are an intractable, but not inevitable feature of the American stratification system. Sub-population groups that bear the brunt of poverty, marginalized labor, discrimination, wage gaps, and segregation---also bear the brunt of poor health (Williams and Collins 1995). This facet of American life has led to an increased focus on health disparities; in fact, Healthy People 2010 (HP2010) has put forth two lofty goals for the health of our nation. While many gains have been made for HP2010's first goal, to increase quality and years of healthy life---negligible gains have been made to meet the second goal---to eliminate health disparities (DHHS 2000). One of the primary impediments for reaching this goal is most certainly our lack of understanding of which social processes generate health disparities and how these disparities persist amidst declining morbidity and mortality rates. It is clear that genetics does not offer a complete answer to the question of persistent disparities (LaVeist 1994, Cooper 1986, Frank 2007). Consequently, investigations into possible social, economic, and structural explanations are necessary in order to better understand the origin and cause of modern health disparities. One of the most disconcerting finding with regards to health disparities is the persistent racial gap in health, mortality, and morbidity. This proposal represents a systematic and ambitious attempt to both understand and explain how these patterns have both persisted and fluctuated over time. By combining demographic, public health, and sociological theory and methods we propose to critically examine the dynamic patterns of racial health disparities, focusing specifically on the "Black/White" health gap, by simultaneously estimating the contribution of age, period, and cohort effects on health trends over time. Specifically, this research project will take an ambitious demographic approach to health disparities by looking at age, period, and cohort effects and how they change temporally to produce health disparities and changes in health disparities over time. This approach could prove to be a major addition to current approaches that simply focus on individual-level effects of survey respondents.
Socioeconimc Status, Intimate Unions, and Health Disparities
Principal Investigator: Rhiannon Kroeger
Faculty Sponsor: Debra Umberson
Funded by: Eunice Kennedy Shriver National Institute of Child Health and Human Development
Reducing and eliminating health disparities has been a central priority of U.S. public health policy for the past two decades (U.S. Department of Health and Human Services, Healthy People 2000; 2010; 2020). Despite an abundance of research investigating socioeconomic status (SES) disparities in health, only modest progress has been made towards their elimination (Center for Disease Control 2011). Notwithstanding the recognition that socioeconomic disparities in health are fundamental causes of disease (Link and Phelan 1995), most scholars agree that policies and interventions aimed at reducing health disparities must be informed by a thorough understanding of the full range of mechanisms and processes through which they are produced (Aneshensel 2002). In the proposed project, Ms. Kroeger argues that socioeconomic status variation in the structure and quality of intimate relationships represents a previously unexplored mechanism that likely contributes significantly to socioeconomic health disparities. She proposes to explore this possibility through considering the following aims: (1) Identify socioeconomic status variation associated with the structure and quality of intimate relationships experienced by adolescents and young adults over time; (2) Determine how socioeconomic variation associated with intimate relationship structure and quality throughout adolescence and young adulthood contributes to socioeconomic disparities in health and health behavior early in the adult life course; (3) Determine how broader social ties with family and peers interact with intimate ties to shape socioeconomic disparities in health and health behavior. In order to fulfill the proposed research plan, Ms. Kroeger requires additional training in areas such as latent growth curve modeling and social network analysis. Moreover, she requires training to cultivate her ability to critically assess the sociological theory linking relationship quality to individual health and well-being. As such, Ms. Kroeger's team of mentors have carefully developed a training plan to advance her statistical, methodological, and professional repertoire in ways that will allow her to examine the research questions outlined in her proposal and to put her in a position to acquire an academic position at a research university. This training plan includes formal coursework and seminars in addition to one-on-one mentoring from her co-sponsors, and is meant not only to further enhance Ms. Kroeger's research skills and methodological approaches, but also to extend her professional networks, develop her publication record, produce a competitive federal grant proposal, and prepare her for success in obtaining an academic position at a research university.
Evaluating the Impact of the Reproductive Health Legislation Enacted by the 82nd Legislature
Principal Investigator: Joseph E. Potter
Additional Investigators: Kristine Hopkins, Co-Investigator
Daniel Grossman, Principal Investigator, Ibis Reproductive Health Subcontract
Kari White, Principal Investigator, Unversity of Alabama at Birmingham
Jon Amastae, Principal Investigator, University of Texas-El Paso Subcontract
Daniel Powers, Co-Investigator
Funded by: Anonymous foundation
The 82nd Texas Legislature enacted key pieces of legislation that will affect women's reproductive health care in the state. Family planning funding was reduced by 2/3 (from $111 million to $38 million) and new abortion restrictions were put in place, while the Medicaid Women's Health Program (WHP) was saved by a budget rider. This project seeks to evaluate the impact of these legislative changes on Texas women and family planning providers. Specifically, this evaluation has 8 primary aims: (1) to evaluate the funding cuts on the family planning clinic budgets, budgets, staffs, hours and locations of clinics, and ultimately the amounts and types of reproductive health services that they are able to provide; (2) to evaluate the impact on the use of contraceptive services - with an emphasis on low-income women - by measuring changes in the numbers of women covered and by investigating whether a shift will occur in the mix of methods provided away from LARC and sterilization toward methods with a lower initial cost; (3) to evaluate the impact on women's experiences seeking care by focusing on whether the cuts affect women seeking to prevent pregnancy or space their births and whether they will be frustrated in their attempts to obtain their preferred method of contraception; (4) to measure the impact on the number of unintended pregnancies, and the proportion intended among all pregnancies; (5) to measure the impact on the total number of births, the number of births to adolescents, and the number of Medicaid births; (6) to measure the impact on the number of abortions taking place in Texas by investigative whether the numbers will fall as a result of the new legal restrictions, or increase as a result of the expected decline in the availability of contraceptive services; and (7) to evaluate the economic impact of any increase in the number of births on public expenditures for medical and social services. Finally, (8) we propose to analyze the political forces that led to the legislation, to identify the main actors in the process, and to better understand the basis of the decisions and processes underlying these legislative changes.
Reconceptualizing Socioeconomic Status and Health
Principal Investigator: Catherine Ross
Additional Investigator: John Mirowsky
Funded by: National Institute on Aging
The primary question is whether collective neighborhood socioeconomic status influences the health of residents adjusting for their own personal or household socioeconomic statuses. If it does, the second question is how. To answer these questions, we propose a reconceptualization of socioeconomic status on both levels. If neighborhood socioeconomic statuses have an effect on residents' health over and above the impact of their own socioeconomic characteristics, we suggest that it is because collective socioeconomic statuses indicate concepts distinct from individual ones. The proposed project will consider the differences between what a measure indicates on the personal level that might affect health and what concept it indicates on the collective level that might affect health. Distinct concepts on the two levels likely have different associations with health and different pathways to health. We delineate three elements of socioeconomic status on the personal and contextual levels: education, work/employment, and economic circumstances. On the neighborhood level we propose that education indicates collective human capital; employment, collective watch; and economic circumstances (especially home ownership), collective interest. Multi-level, multi-indicator structural equation models will allow us to distinguish separate elements of neighborhood socioeconomic status, which most previous research on neighborhoods and health has not. Distinguishing and defining elements of socioeconomic status on the personal and contextual level is the first step necessary in order to examine associations between health and neighborhood socioeconomic status and it's elements, and compare these results to personal socioeconomic statuses. For instance, on the personal level economic hardship may be the economic element with the strongest relationship to health; on the neighborhood level, the prevalence of home ownership may be. Next we propose to explain the associations. We focus on two main explanations linking neighborhoods to health: the neighborhood context of disorder and stress, and health lifestyle. The analyses will use data from our 1995 survey of Community, Crime and Health (CCH), a probability sample of Illinois households with linked census tract information, and a follow-up in 1998.
Gene-Environment Interplay in Early Cognitive Development
Principal Investigator: Elliot Tucker-Drob
Additional Investigator: Paige Harden
Funded by: Eunice Kennedy Shriver National Institute of Child Health and Human Development
While the influences of genes and environments on cognitive development have traditionally been viewed as independent, if not competing, forces, there is an emerging theoretical consensus that cognitive development results from interactions between genes and cumulative environmental experiences. However, while the little gene-by-environment (G×E) interaction research on cognitive development that has been conducted to date has primarily focused on children's experiences during grade school, very recent work suggests that G×E on cognitive development emerges much earlier - as early as 2 years of age. In low socioeconomic status homes, genetic influences on infant cognitive function approach zero, whereas in high socioeconomic status homes, genes account for approximately 50% of the variation in infant cognitive function. Using data on approximately 800 pairs of fraternal and identical twins that were collected as part of the Early Childhood Longitudinal Study - Birth Cohort (ECLS-B), this project will take steps to clarify G×E interaction effects on early cognitive development in three important respects.
Aim 1. Identify Parent Behaviors that Moderate Genetic Influences on Infant Cognitive Function. For the first aim, this project will examine the roles that parent behaviors play in moderating genetic influences on infant cognitive function. A guiding hypothesis is that parental responsiveness to infant cues is crucial to the expression of genetic potential for early cognitive development.
Aim 2. Understand the Association Between Infant Behaviors and Infant Cognitive Function. For the second aim, this project will examine the genetic and environmental bases for the relations between infant knowledge-seeking behaviors and infant cognitive function, and whether socioeconomic advantage and parental responsiveness moderate these relations. This will help to determine whether G×E interactions on infant cognitive functions can be accounted for by differences in levels of support of children's knowledge-seeking behaviors.
Aim 3. Link G×E Effects on Cognitive Function with School Entry Skills in Kindergarten. For the final aim, this project will examine the extent to which G×E effects on infant cognitive function extend to school entry skills (mathematics, reading, and attentional skills) measured at 4 and 5 years, and whether new G×E effects independent of previous G×E effects emerge at school entry.
Identifying early life experiences that facilitate the expression of genes for healthy cognitive development and school readiness will support NICHD's mission to ensure that "all children have their chance to achieve their full potential for healthy and productive lives."
Marriage, Gender and Health in Lesbian, Gay and Heterosexual Couples
Principal Investigator: Debra Umberson
Funded by: Robert Wood Johnson Foundation
Married heterosexuals are healthier and live longer than the unmarried; however, since same-sex couples cannot legally marry in most parts of the United States, we know very little about the health implications of marriage for gay and lesbian couples. This project will provide the first in-depth and systematic analysis of legal marriage, cohabitation, and health to compare heterosexual, gay, and lesbian couples. In-depth interviews with both partners in same-sex and heterosexual married couples in Massachusetts will allow us to consider how individuals perceive and experience their marriage with regard to health behavior, informal care for a partner during periods of illness or injury, and the use of formal health care systems. A comparison of cohabiting and married gay, lesbian, and heterosexual couples will allow us to explore further how legal marriage differs from cohabiting unions in shaping relationship dynamics around health. This project is innovative in including both married and cohabiting gay and lesbian couples, groups that have been neglected in research on health; uncovering how people in different types of committed relationships take care of one another, both informally and through health care systems; analyzing how gender influences relationship and health processes; and examining challenges as well as benefits of committed relationships for health. This project will inform health policy involving when and how marriage and cohabitation influence health behavior, and how partner dynamics around health care at home and in formal health care settings vary for different union types. Policy strategies that result in more health-promoting habits, more effective partner participation in health care, and more efficient use of health care systems have the potential to reduce health care costs, while also improving the health and well-being of individuals and couples.
