ABSTRACT
We evaluated the role of the neurotoxicant lead (Pb) in mediating racial disparities in later-life cognition in 1,085 non-Hispanic Black and 2,839 non-Hispanic white participants in NHANES (1999-2002, 2011-2014) 60+ years of age. We operationalized Black race as a marker for the experience of racialization and exposure to systemic racism. We estimated patella bone Pb via predictive models using blood Pb and demographics. Concurrent cognition (processing speed, sustained attention, working memory) was measured by the Digit Symbol Substitution Test (DSST) and a global measure combining four cognitive tests. To obtain the portion mediated, we used regression coefficients (race on Pb * Pb on cognitive score)/(race on cognitive score), adjusting for age, NHANES cycle, and sample weights. Other confounder adjustment (education, poverty income ratio, smoking) was limited to the mediator-outcome (i.e., Pb-cognition) pathway because these factors do not lie upstream of race and so cannot confound associations with race. Pb was estimated to mediate 0.6% of the association between race and global cognition, and 4% of the DSST. Our results suggest that later-life cognitive health disparities may be impacted by avoidable lead exposure driven by environmental injustice, noting that a large proportion of the pathway of systemic racism harming cognition remains.
ABSTRACT
INTRODUCTION: Understanding differences in predictors of adolescent cigarette smoking and e-cigarette use can inform public health strategies for preventing and reducing tobacco use among this population. The objective of this study was to examine the association of socioeconomic, psychosocial, and behavioral factors with cigarette smoking and e-cigarette use among adolescents in Minnesota. METHODS: Records (n = 126,868) were used from the 2016 Minnesota Student Survey for prevalence of and factors associated with cigarette smoking and e-cigarette use among students in grades 8, 9, and 11. Logistic regression models were used to estimate risk for smoking cigarettes, using e-cigarettes, or concurrent use of both for key independent variables. RESULTS: American Indian students were 3.6 times as likely to report smoking cigarettes (OR = 3.57; 95% CI, 3.04-4.19), and 1.7 times as likely to report using e-cigarettes (OR = 1.72; 95% CI, 1.47-2.01) as non-Hispanic white students. Bisexual students were 4 times as likely (adjusted odds ratio [AOR] = 4.40; 95% confidence interval [CI], 4.01-4.82) as heterosexual students to smoke cigarettes and twice as likely (AOR = 2.24; 95% CI, 2.06-2.43) to use e-cigarettes. Students receiving free/reduced lunch were nearly twice as likely (AOR = 1.92; 95% CI, 1.80-2.05) to smoke cigarettes and 1.3 times as likely (AOR = 1.33; 95% CI, 1.27-1.39) to use e-cigarettes. Increasing alcohol use and decreasing academic performance were associated with increasing likelihood of cigarette smoking and e-cigarette use, more so with cigarette smoking. CONCLUSION: Results expand on existing research that show differences in psychosocial and behavioral risk factors between adolescent cigarette smokers and adolescent e-cigarette users.
