The importance of education for understanding variability of dementia onset in the United States.

BACKGROUND: Greater levels of education are associated with lower risk of dementia, but less is known about how education is also associated with the compression of dementia incidence. OBJECTIVE: We extend the literature on morbidity compression by evaluating whether increased levels of education are associated with greater dementia compression. We evaluate these patterns across race and gender groups. METHODS: We use the Health and Retirement Study (2000-2016), a nationally representative longitudinal study of older adults in the United States. To evaluate the onset and compression of dementia across education groups, we examine the age-specific distribution of dementia events, identifying the modal age of onset and the standard deviation above the mode (a measure of compression). RESULTS: While the modal age of onset is around 85 years among adults with a college degree, the modal age for adults with less than a high school education occurs before age 65 - at least a 20-year difference. The standard deviation of dementia onset is about three times greater for adults with less than a high school education compared to adults with a college degree. Patterns were consistent across race and gender groups. CONCLUSION: This research highlights the variability of dementia experiences in the older population by documenting differences in longevity without dementia and compression of dementia onset among more educated adults and less educated adults. CONTRIBUTION: We incorporate conceptual insights from the life span variability and compression literature to better understand education-dementia disparities in both the postponement and uncertainty of dementia onset in the US population.

A Time of Healing: Can Social Engagement After Bereavement Reduce Trajectories of Depression After the Death of a Child?

OBJECTIVES: We work from a stress and life-course perspective to examine the mental health of parents who experienced the death of their child. We examine whether mental health eventually returns to pre-bereavement levels and how social engagement after bereavement may shape the recovery process of depressive symptoms. METHODS: We analyze discontinuous growth curve models to assess the association between a child's death and trajectories of parents' depressive symptoms from the 1998-2016 Health and Retirement Study. The sample includes 16,182 parents aged 50 years and older. RESULTS: Those who transitioned to bereavement experienced an elevation in depressive symptoms and a relatively long recovery time (e.g., 7 years) to their pre-bereavement mental health in our findings. However, when engaging in volunteer work after their loss, depressive symptoms reduce more quickly to their pre-bereavement levels. Volunteering offsets up to 3 years of the negative consequences of child loss. DISCUSSION: The death of a child is a traumatic event with extensive health consequences, but research should more fully examine the dynamic nature and potential mitigation of these health consequences over time. Our findings expand the temporal lens to encompass healing processes after bereavement, incorporating the importance of social engagement.

What Explains Socioeconomic Disparities in Early Pregnancy Rates?

In this study, we integrate diverse structural, social psychological, and relational perspectives to develop and test a comprehensive framework of the processes that make early pregnancy a socially stratified phenomenon. Drawing on rich panel data collected among a sample of 940 18- to 20-year-old women from a county in Michigan, we estimate nested hazard models and formal mediation analyses to simultaneously elucidate the extent to which different mechanisms explain disparities in early pregnancy rates across maternal education levels-a key indicator of socioeconomic status. Together, our distal mechanisms explain 53 and 31 percent of the difference in pregnancy rates between young women whose mothers graduated college and young women whose mothers graduated and did not graduate high school, respectively. Reproductive desires, norms, and attitudes, relationship contexts, and educational opportunities and environment each link maternal education to young women's odds of pregnancy. Self-efficacy, however, plays only a modest role; while contraceptive affordability and knowledge are not significant pathways. These findings bring into focus the most prominent intervening mechanisms through which socioeconomic circumstances shape young women's likelihood of becoming pregnant during the transition to adulthood.

Exposure to Family Member Deaths Across the Life Course for Hispanic Individuals.

The present study documents differences in exposure to family member deaths among foreign-born and U.S.-born Hispanic individuals compared with non-Hispanic Black and non-Hispanic White individuals. We use data from the Health and Retirement Study (HRS; 1992-2016, ages 51+; N = 23,228) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; Waves I-V, ages 12-43; N = 11,088) to estimate the risk of exposure to the death of a mother, father, spouse, sibling, and child across the life course. HRS results show more inequities in exposure to family deaths compared with Add Health results, suggesting differences by age or birth cohort. Compared with non-Hispanic Whites, U.S.-born Hispanic individuals in the HRS have a higher risk of experiencing a child's death throughout adulthood and a sibling's death in later life; the latter is explained by larger sibship size, indicating a greater lifetime risk of bereavement experiences. The higher risk of parental death during childhood for U.S.-born and foreign-born Hispanic individuals is explained by covariates (e.g., lower levels of educational attainment). Hispanic individuals generally have a lower risk of family deaths than non-Hispanic Black individuals, but at times a higher risk of exposure relative to non-Hispanic White individuals.

Multiple Family Member Deaths and Cardiometabolic Health among Black and White Older Adults.

Although the bereavement literature is voluminous, we know very little about how exposure to multiple family member deaths across the life course shapes health trajectories as people age and whether unequal exposure to bereavement contributes to racial inequities in cardiometabolic health. We use longitudinal data from the Health and Retirement Study (1992-2016) to consider how multiple family member deaths before midlife shape trajectories of cardiometabolic health after age 50 for Black and white adults (n = 22,974). Results show that multiple family member deaths prior to age 50 are associated with more cardiometabolic conditions at age 50 and a faster increase in conditions with advancing age. Moreover, Black adults are significantly disadvantaged by a greater risk of bereavement and more cardiometabolic conditions regardless of bereavement status. The life course trauma of exposure to multiple family member deaths uniquely contributes to the cardiometabolic risk of Black Americans.

Gender and Social Isolation across the Life Course.

Social isolation has robust adverse effects on health, well-being, dementia risk, and longevity. Although most studies suggest similar effects of isolation on the health of men and women, there has been much less attention to gendered patterns of social isolation over the life course-despite decades of research suggesting gender differences in social ties. We build on theoretical frames of constrained choice and gender-as-relational to argue that gender differences in isolation are apparent but depend on timing in the life course and marital/partnership history. Results indicate that boys/men are more isolated than girls/women through most of the life course, and this gender difference is much greater for the never married and those with disrupted relationship histories. Strikingly, levels of social isolation steadily increase from adolescence through later life for both men and women.

Past, present, and future dimensions of socioeconomic status and sexual self-efficacy of young women during the transition into adulthood.

Socioeconomic disadvantages can undermine a person's ability to control their sexual lives (sexual self-efficacy) during the transition to adulthood. Most scholarship focuses on proximate circumstances, specifically how sexual self-efficacy is a result of current socioeconomic status. Yet, this sexual agency is embedded within much longer behavioral and psychological trajectories shaped by socioeconomic contexts. Therefore, I identify a novel explanation for sexual self-efficacy by connecting it to past, present, and anticipatory future conceptualizations of young adults' socioeconomic circumstances. Drawing from 2.5 years of quarterly data from the Relationship Dynamics and Social Life Study, I found significant associations between more advantaged past, present, and anticipatory future socioeconomic circumstances and greater sexual self-efficacy during the transition to adulthood. Stage-specific dimensions of socioeconomic status (SES) followed two life course patterns (pathways and accumulation). In addition, prospective SES was found to be a more powerful predictor than childhood and current SES. As such, I encourage researchers to conceptualize socioeconomic status in life course terms to illuminate the underlying causes and consequences of varying young adulthoods.

Sibling Deaths, Racial/Ethnic Disadvantage, and Dementia in Later Life.

OBJECTIVES: Sibling loss is understudied in the bereavement and health literature. The present study considers whether experiencing the death of siblings in mid-to-late life is associated with subsequent dementia risk and how differential exposure to sibling losses by race/ethnicity may contribute to racial/ethnic disparities in dementia risk. METHODS: We use discrete-time hazard regression models, a formal mediation test, and a counterfactual simulation to reveal how sibling loss in mid-to-late life affects dementia incidence and whether unequal exposures by race/ethnicity mediate the racial/ethnic disparities in dementia. We analyze data from the Health and Retirement Study (2000-2016). The sample includes 13,589 respondents (10,670 non-Hispanic White, 1,761 non-Hispanic Black, and 1,158 Hispanic adults) aged 65 years and older in 2000 who show no evidence of dementia at baseline. RESULTS: Discrete-time hazard regression results show that sibling loss in mid-to-late life is associated with up to 54% higher risk for dementia. Sibling loss contributes to Black-White disparities in dementia risk. In addition, a simulation analysis shows that dementia rates would be 14% lower for Black adults if they experienced the lower rates of sibling loss experienced by White adults. This pattern was not observed among Hispanic adults. DISCUSSION: The death of a sibling in mid-to-late life is a stressor that is associated with increased dementia risk. Black adults are disadvantaged in that they are more likely than Whites to experience the death of siblings, and such losses contribute to the already substantial racial/ethnic disadvantage in dementia.

Socioeconomic status across the life course and dementia-status life expectancy among older Americans.

This study examines how socioeconomic status (SES) across the life course is associated with individuals' lifetime dementia experience - the years of life persons can expect to live and without with dementia. Conceptually, dementia-free life expectancy reflects the ability to postpone dementia onset while dementia life expectancy reflects the average lifetime period with the condition. How SES across the life course contributes to dementia-status life expectancy is the focus of this study. We assess whether persons who are advantaged in their lifetime SES live the most years without dementia and the fewest years with dementia compared to less advantaged persons. Using the Health and Retirement Study (2000-2016), we examine these questions for U.S. adults aged 65 and older using multistate life tables and a microsimulation approach. The results show that higher SES persons can expect to live significantly more years of life without dementia and that the period of life with dementia is compressed compared to less advantaged persons. The results also underscore that importance of cumulative exposure, showing that adults from disadvantaged childhoods who achieve high education levels often have dementia experiences that are similar to or better than those of adults from advantaged childhoods who achieved low education levels.